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. 2019 Jan-Mar;14(1):175-180.
doi: 10.4103/ajns.AJNS_137_18.

Venture in 101 Cranial Punctures: A Comparative Study between Frame-based versus Frameless Biopsy of 101 Intracranial Space Occupying Lesion

Suresh Bishokarma  1 , Pratyush Shrestha  1 , Sagar Koirala  1 , Manita Raut  1 , Dinesh Nath Gongal  1
Affiliations

Venture in 101 Cranial Punctures: A Comparative Study between Frame-based versus Frameless Biopsy of 101 Intracranial Space Occupying Lesion

Suresh Bishokarma et al. Asian J Neurosurg. 2019 Jan-Mar.

Abstract

Background: Presumptive diagnosis based solely on the clinical picture and imaging is not sufficient to provide appropriate treatment with certainty and hence histopathological confirmation of intracranial space occupying lesion (ICSOL) is essential. Needle biopsy via stereotactic frame-based or frameless neuronavigation technique is efficient procedure. The objective of this study is to compare their accuracy and efficacy and safety.

Methods: This is a retrospective comparative study conducted among 101 biopsies of ICSOL. Patients data were retrieved from medical record. Data were analyzed in SPSS ver. 20. P value of <0.05 was considered significant.

Results: Out of 101 patients, Frame-based stereotactic biopsy was done among 55 patients (54.4%) while 46 patients (45.6%) underwent frameless stealth neuronavigation guided biopsy. Male to female ration was 2.1:1. Age ranged from 5 to 82 years. 54.5% (55 patients) have deeper location of tumor while 45.5% (46 patients) have lobar location of tumor. Frontal (16.8%) and Thalamic (13.8%) were the common site. Mean size of tumor was 3.09±0.85cms. There was statistically significant difference in operative duration among study groups. Overall Diagnostic yield was 89.1%. Glioma was the most common (50.5%) diagnosis. Glioblastoma WHO Grade IV was 37.6% followed by lymphoma (12.8%).

Conclusion: Needle biopsy via stereotactic frame-based or neuronavigation frameless technique is a safe and efficient procedure having high diagnostic yield. Reasons for negative biopsy could be missed target or retrieval of gliotic tissue.

Keywords: Biopsy; accuracy; brain lesion; frame-based; frameless; neuronavigation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Localizer ring secured in the outer table of the skull, (b) Patient in CT console with frame fixed on the head, (c) Rectilinear phantom pointer (RLPP) with CRW stereotactic frame calibrated to phantom target, (d) CRW frame is mounted on patient head for biopsy of target lesion
Figure 2
Figure 2
(a) Head fixed with three pins clamp on Mayfield, (b) Target lesion is navigated and locked for biopsy from shortest safe route, (c) Burr hole and durostomy before biopsy, (d) Delivering Biopsy specimen for Histopathological examination
See this image and copyright information in PMC

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