The advantages of frameless stereotactic biopsy over frame-based biopsy

Abstract

A comparison study is presented, which examines the outcome, complications and cost of stereotactic brain biopsy performed with a frameless versus a frame-based method. The technique of frameless stereotactic biopsy has been shown previously, in both laboratory and in vivo studies, to achieve a level of accuracy at least equal to frame-based biopsy. The investigators have validated the technique in a large clinical series. The frameless and frame-based series were concurrent, comprising 76 and 79 cases, respectively. The frameless stereotactic technique involved standard needle biopsy, targeted by an image-guidance system and directed by a novel rigid adjustable instrument-holder. Frame-based biopsies were performed with the CRW and Leksell systems. There were no significant differences in the demographics, lesion site, size and pathologies between the groups. Operating theatre occupancy and anaesthetic time were both significantly shorter for the frameless series than the frame-based series (p < 0.0001). In addition, the complication rate in the frameless biopsy series was significantly lower than in the frame-based series (p = 0.018). This resulted in lower ITU bed occupancy (p = 0.02), shorter mean hospital stay (p = 0.0013) and significant cost savings (p = 0.0022) for the frameless stereotactic biopsy group, despite the greater use of more expensive MRI in these cases. This comparison study demonstrates that the superior imaging, target visualization and flexibility of the technique of frameless stereotactic biopsy translates into tangible advantages for safety, time and cost when compared with the current gold-standard of frame-based biopsy. The principles are discussed and the authors propose a definition for the term 'frameless stereotaxy'.

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

“…The risks of general anesthesia need to be considered, and the FB technique has traditionally been accomplished with local anesthesia and sedation. However in at least two comparative series, the surgeons induced general anesthesia in all patients [8,11]. This clearly influenced the outcome measure of total time and cost, which both studies found to favor FL.…”

“…Some early reports have suggested that FL techniques are as good or better than the traditional frame-based approach [8,9]. Recent large series seem to indicate similar diagnostic yields and complication rates, but have failed to agree upon factors such as differences in cost and operating room time between the two methods [10,11].…”

Frameless Stereotactic Surgery Using Intraoperative High-Field Magnetic Resonance Imaging

“…The frameless stereotaxy technique can eliminate the cumbersome head frames, including the time for application, and achieved an accuracy comparable to frame-based stereotaxy. 1,3,4,14,22) Intraoperative magnetic resonance (iMR) imaging and MR-compatible devices have been developed for stereotactic procedures. Two different approaches to the clinical application of iMR imaging have been reported: low-field iMR imaging for stereotactic procedures because of the easy access to patients due to the open configuration, 2,16,25,26) and high-field MR imaging.…”

Stereotactic biopsy for intracranial lesions: clinical-pathological compatibility in 60 patients

“…The clinical indication is precise for those cases of unclear diagnosis where the precise nature is not clear. Despite high anatomical accuracy given by computed tomography (CT) and magnetic resonance imaging (MRI), pathological analysis does not always provide the correct diagnosis to the physician, leading to possible underestimation for the lesion heterogeneity and diffuse vascularization [5][6][7][8][9][10][11][12][13][14] .…”

“…A recent meta-analysis including 7471 patients showed positivity for histopathological diagnosis of SB material in 91% of the cases, with morbidity rates of 3.5% and mortality rates of 0.7% 5 , while transitory neurological deficits were reported in 9% of the patients [6][7][8][9][10][11][12][13][14] . We present a critic analysis of clinical outcome and lesion's behavior associated with pathologic findings and correspondence in the long term outcome.…”