Safety and reliability of frameless stereotactic biopsy in supratentorial cerebral lesions. Experience with 42 cases

Introduction. Brain needle biopsy with stereotactic frame is a standard procedure of proven reliability. Frameless stereotactic biopsy with neuronavigation has increasingly spread as an alternative technique. We reviewed our experience with frameless stereotactic biopsy, to determine the safety and effectiveness of this technique. Methods. Forty-two consecutive cases of supratentorial brain lesion undergoing frameless needle biopsy with neuronavigation were retrospectively analyzed for operation time, operative complication rate, mortality and morbidity, length of postoperative in hospital stay, sensitivity of the biopsy and consistency with the pathological findings in 14 (33.3%) eventually operated patients. Results. There were 31 (75%) men and 11 (25%) women, mean age was 57.7 years. Operation time was 35′ to 105′ (mean 68′). One patient (2.3%) died due to massive haemorrhage within a glioblastoma 3 days after biopsy. No morbidity was recorded. Mean postoperative in hospital stay was 5.3 days in 27 (66.6%) patients not undergoing further surgical treatment. Sensitivity was 100%. In 14 eventually operated patients, biopsy results were consistent with open surgery pathological findings. Conclusions. In our experience, frameless stereotactic biopsy was safe and effective and its reliability was high. Compared to conventional stereotaxy, it needs a simpler preoperative setup and brings the patient no discomfort. Based on our data, we consider frameless stereotaxy with neuronavigation a standard procedure for needle biopsy in supratentorial lesions greater than 1 cm in diameter.