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. 2019 Jan-Mar;10(1):78-84.
doi: 10.4103/jnrp.jnrp_166_18.

Diagnostic Yield and Complication of Frameless Stereotactic Brain Biopsy

Chin Taweesomboonyat  1 , Thara Tunthanathip  1 , Sakchai Sae-Heng  1 , Thakul Oearsakul  1
Affiliations

Diagnostic Yield and Complication of Frameless Stereotactic Brain Biopsy

Chin Taweesomboonyat et al. J Neurosci Rural Pract. 2019 Jan-Mar.

Abstract

Background: With the advancement of neuronavigation technologies, frameless stereotactic brain biopsy has been developed. Previous studies proved that frameless stereotactic brain biopsy was as effective and safe as frame-based stereotactic brain biopsy. The authors aimed to find the factors associated with diagnostic yield and complication rate of frameless intracranial biopsy.

Materials and methods: Frameless stereotactic brain biopsy procedures, between March 2009 and April 2017, were retrospectively reviewed from medical records including imaging studies. Using logistic regression analysis, various factors were analyzed for association with diagnostic yield and postoperative complications.

Results: Eighty-nine frameless stereotactic brain biopsy procedures were performed on 85 patients. The most common pathology was primary central nervous system lymphoma (43.8%), followed by low-grade glioma (15.7%), and high-grade glioma (15%), respectively. The diagnostic yield was 87.6%. Postoperative intracerebral hematoma occurred in 19% of cases; however, it was symptomatic in only one case. The size of the lesion was associated with both diagnostic yield and postoperative intracerebral hematoma complication. Lesions, larger than 3 cm in diameter, were associated with a higher rate of positive biopsy result (P = 0.01). Lesion 3 cm or smaller than 3 cm in diameter, and intraoperative bleeding associated with a higher percentage of postoperative intracerebral hematoma complications (P = 0.01).

Conclusions: For frameless stereotactic brain biopsy, the size of the lesion is the essential factor determining diagnostic yield and postoperative intracerebral hematoma complication.

Keywords: Diagnostic yield; frameless stereotactic brain biopsy; neuronavigation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Postoperative intralesional pneumocephalus. (a) Preoperative contrast enhanced- computed tomography scan of the brain showed a 3-cm diameter enhancing periventricular fourth ventricular mass. (b) Postoperative computed tomography of the brain showed intralesional pneumocephalus without intracranial hematoma
Figure 2
Figure 2
Diagnostic yield, according to the lesion size. According to conditional inference trees, the diameter of the lesion associated with diagnostic yield (node 1, P = 0.01). There was a 78% diagnostic yield in diameter of lesions 3 cm, or less, (node 2). Conversely, lesions larger than 3 cm have a 95.8% diagnostic yield (node 3)
Figure 3
Figure 3
Intraoperative bleeding through the biopsy needle
Figure 4
Figure 4
Risk of postoperative intracerebral hemorrhage. According to conditional inference trees, size of the lesion was associated with bleeding complication (node 1, P = 0.01). The small lesions (3 cm and less in diameter) were 78% of postoperative bleeding (node 2) while lesion larger than 3 cm without intraoperative bleeding have complication of about 2.4 (node 4). Lesions larger than 3 cm, with intraoperative bleeding, were observed in 42.9%. Intraoperative bleeding was a statistically significant indicator to predict postoperative complications (node 5, P < 0.001)
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