Stereotactic Biopsy for Brainstem Lesions: A Meta-analysis with Noncomparative Binary Data

Abstract

Objectives To evaluate the diagnostic yield and safety of brainstem stereotactic biopsy for brainstem lesions. Methods We performed a meta-analysis of English articles retrieved from the PubMed, Web of Science, Cochrane Library, and APA psycInfo databases up to May 12, 2021. A binary fixed-effect model, the inverse variance method, or a binary random-effect model, the Dersimonian Laird method, were utilized for pooling the data. This meta-analysis was registered with INPLASY, INPLASY202190034. Findings A total of 41 eligible studies with 2792 participants were included. The weighted average diagnostic yield was 97.0% (95% confidential interval [CI], 96.0-97.9%). The weighted average proportions of temporary complications, permanent deficits, and deaths were 6.2% (95% CI, 4.5–7.9%), .5% (95% CI, .2–.8%), and .3% (95% CI, .1–.5%), respectively. The subgroup analysis indicated a nearly identical weighted average diagnostic yield between MRI-guided stereotactic biopsy and CT-guided stereotactic biopsy (95.9% vs 95.8%) but slightly increased proportions of temporary complications (7.9% vs 6.0%), permanent deficits (1.9% vs .2%), and deaths (1.1% vs .4%) in the former compared to the latter. Moreover, a greater weighted average diagnostic yield (99.2% vs 97.6%) and lower proportions of temporary complications (5.1% vs 6.8%) and deaths (.7% vs 1.5%) were shown in the pediatric patient population than in the adult patient population. Conclusions Brainstem stereotactic biopsy demonstrates striking accuracy plus satisfying safety in the diagnosis of brainstem lesions. The diagnostic yield, morbidity, and mortality mildly vary based on the diversity of assistant techniques and subject populations.

The Role of Stereotactic Frame-Based Biopsy for Brainstem Tumors in the Era of Molecular-Based Diagnosis and Treatment Decisions

“…In previous reports, the diagnostic rate of brainstem tumor biopsy varied from 84% to 97% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ], which are comparable to our results. Regarding the approach, the transfrontal and transcerebellar routes are the two major surgical routes [ 11 , 15 , 16 , 17 ]; however, there is a paucity of evidence as to which approach is more suitable [ 13 , 14 , 18 ].…”

“…In previous reports, the rate of major complications or permanent disability owing to SFB was approximately 0.5–3% [ 7 , 8 , 9 , 10 , 17 , 18 ], and there was no death, postoperative hemorrhage, or permanent morbidity in our series, indicating greater safety than has been reported in previous studies. Complications can be reduced by careful examination of preoperative images for, for instance, the presence of blood vessels in the trajectory, and to avoid eloquent areas as the targets.…”

“…Stereotactic frame-based brain tumor biopsy (SFB) is a modern surgical technique that enables highly accurate targeting through a burr hole guided by high resolution magnetic resonance imaging (MRI) taken under rigid head fixation. To date, numerous studies, including meta-analyses, have revealed the efficacy and safety of SFB [ 7 , 8 , 9 ]; however, there are only a few studies on brainstem tumors, and the safety and efficacy of SFB for such tumors remain unclear. In 2002, our institution initiated a multidisciplinary approach including SFB-based collection of tumor specimens for brainstem lesions.…”

Stereotactic frame-based biopsy of infratentorial lesions via the suboccipital-transcerebellar approach with the Zamorano-Duchovny stereotactic system—a retrospective analysis of 79 consecutive cases

“…Consequently, we hypothesize that the use of intraoperative MRI is not inferior to CT scans fused with preoperative MRI sequences in terms of complications and diagnostic success, in good accordance with other published literature [ 1 ]. Therefore, our study underlines the findings of Neumann et al (2018) where a non-inferiority of MRI-based biopsies compared to CT-based biopsies was initially described with a large number of cases and recently published meta-analyzes showed more evidence regarding the equality of MRI and CT [ 6 , 18 ]. Our study specified these findings in a sub-cohort and proved intraoperative MRI to be safe to use also for posterior fossa biopsies via the suboccipital approach.…”

Liquid biopsy in pediatric brain tumors

“…Therefore, current clinical decision-making requires surgical biopsy or resection for histopathologic diagnosis. Even the most minimally invasive option-stereotactic needle biopsy-puts the patient at risk of side effects of general anesthesia, intracranial hemorrhage, neurologic deficit, and death (Nishihara et al, 2011;Hamisch et al, 2017;He et al, 2021). Furthermore, tissue biopsy samples a single point, failing to capture intratumoral heterogeneity for accurate diagnosis (Ng and Lim, 2008).…”