Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy
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Object: As the availability of image-guided surgical navigation systems has increased, the application of frame-based biopsy has declined at our institution, despite equivalent accuracy and safety. There are several cost issues separating the use of surgical navigation systems and stereotactic frames for simple biopsy which may have implications in this era of health care cost control. We retrospectively reviewed the UCSF experience with stereotactic brain biopsy from a 9 year period. Methods: Data were collected for 213 consecutive stereotactic brain biopsies performed at UCSF (139 frame-based and 74 frameless). There were no significant differences between the frame-based and frameless biopsy groups with regard to patient demographics, overall histopathology, proportion of nondiagnostic biopsies, or incidence of complications. General anesthesia was used for 9 (6%) and 70 (95%) of the frame-based and frameless biopsy cases, respectively. Frame-based biopsies required a mean of 114 ± 3 min of operating room time, while frameless biopsies required 185 ± 6 min (P < 0.0001). For patients admitted to our neurosurgery service who underwent frame-based (n=110) or frameless (n=52) biopsy within 24 h of admission, the mean lengths of hospital stay were 1.8 ± 0.2 and 3.2 ± 0.6 days, respectively (P=0.007). Conclusion: Frame-based and frameless stereotactic biopsy approaches were equally effective at providing a tissue diagnosis with minimum morbidity and mortality. The frame-based approach, however, required significantly less anesthesia resources, less operating room time and shorter hospital stays, and thus should still be considered a first-line approach for stereotactic brain biopsy.
Keywordsbrain biopsy CRW frame-based biopsy frameless biopsy Stealth stereotactic biopsy
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- 1.Moriarty, TM, Quinones-Hinojosa, A, Larson, PS, Alexander, E,3rd, Gleason, PL, Schwartz, RB, Jolesz, FA, Black, PM. 2000Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: stereotactic brain biopsyNeurosurgery4711381145Discussion 1145–1136, 2000CrossRefPubMedGoogle Scholar
- 3.Wen, DY, Hall, WA, Miller, DA, Seljeskog, EL, Maxwell, RE. 1993Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniquesNeurosurgery,32407412Discussion 412–413Google Scholar
- 8.Dorward, NL, Alberti, O, Palmer, JD, Kitchen, ND, Thomas, DG. 1999Accuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studiesTechnical note. J Neurosurg90160168Google Scholar
- 10.Apuzzo, ML, Chandrasoma, PT, Cohen, D, Zee, CS, Zelman, V. 1987Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain massesNeurosurgery20930937Google Scholar
- 11.Quinones-Hinojosa A, Sanai N, McDermott MW. (1999). Assessment of image guided accuracy using two types of disposable biopsy guides as compared to frame-based localization. American Association of Neurological Surgeons Abstract Archive (http: //www.aans.org/Library/Article.aspx?ArticleId = 12387), 2002Google Scholar