Perioperative Outcomes of Patients Undergoing Frame Based Stereotactic Brain Biopsies

Zermina  Tanvir; Muhammad  Rizwan; Zahid  Shah; Zunaira  Tanvir; Naveed  Akhtar; Liaquat Ali  Jalal

doi:10.54112/bcsrj.v6i4.2101

Authors

Zermina Tanvir Department of Neurosurgery, Nishtar Medical University Hospital Multan, Pakistan
Muhammad Rizwan Department of Neurosurgery, Nishtar Medical University Hospital Multan, Pakistan
Zahid Shah Department of Neurosurgery, Nishtar Medical University Hospital Multan, Pakistan
Zunaira Tanvir District Headquarters Khanewal, Pakistan
Naveed Akhtar Department of Neurosurgery, Nishtar Medical University Hospital Multan, Pakistan
Liaquat Ali Jalal Department of Neurosurgery, Nishtar Medical University Hospital Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i4.2101

Keywords:

Biopsy; Brain Neoplasms; Neurosurgery; Pakistan; Postoperative Complications; Stereotactic Techniques

Abstract

Frame-based stereotactic brain biopsy is an established minimally invasive neurosurgical technique for obtaining tissue diagnosis of intracranial lesions, particularly when lesions are deep-seated or surgically inaccessible. Its safety and efficiency in resource-limited settings require continued local evaluation. Objective: To assess perioperative outcomes, including complication rates, operative time, and length of hospital stay in patients undergoing frame-based stereotactic brain biopsy at a tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted over six months from September 2024 to February 2025 at the Department of Neurosurgery, Nishtar Hospital, Multan. Ninety-seven patients aged 20 to 65 years who underwent frame-based stereotactic brain biopsy were enrolled using non-probability consecutive sampling. Demographic data, lesion characteristics, operative time, duration of hospital stay, and perioperative complications were recorded on a structured proforma. Data were analyzed using SPSS version 25. Quantitative variables were expressed as mean and standard deviation, while qualitative variables were presented as frequencies and percentages. Associations between complications and patient or lesion characteristics were assessed using the chi-square test, with p-values <0.05 considered statistically significant. Results: The mean age of patients was 46.7 ± 12.1 years, with a male-to-female Ratio of 1.5:1. The most common lesion locations were the frontal lobe (22.7%) and the parietal lobe (18.6%). Mean operative time was 46.2 ± 10.8 minutes, and the average hospital stay was 3.4 ± 1.6 days. Perioperative complications were observed in 14 patients (14.4 percent), including intracranial hemorrhage in 7 patients (7.2 percent) and new onset neurological deficits in 7 patients (7.2 percent). Higher complication rates were noted among older patients and those with deep-seated lesions, though these differences were not statistically significant (p > 0.05). Conclusion: Frame-based stereotactic brain biopsy is a safe and effective diagnostic procedure with acceptable operative time, short hospital stay, and low complication rates in a tertiary care setting in Pakistan. These findings support its continued use as a reliable neurosurgical diagnostic modality in resource-constrained environments.

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References

Kesserwan M., Shakil H., Lannon M., McGinn R., Banfield L., Nath S.et al.. Frame-based versus frameless stereotactic brain biopsies: a systematic review and meta-analysis. Surgical Neurology International 2021;12:52. https://doi.org/10.25259/sni_824_2020

Majewska P., Sagberg L., Reinertsen I., Gulati S., Jakola A., & Solheim O. What is the current clinico‐radiological diagnostic accuracy for intracranial tumours?. Acta Neurologica Scandinavica 2021;144(2):142-148. https://doi.org/10.1111/ane.13430

Hirano Y., Shinya Y., Aono T., Hasegawa H., Kawashima M., Shin M.et al.. The role of stereotactic frame-based biopsy for brainstem tumors in the era of molecular-based Diagnosis and treatment decisions. Current Oncology 2022;29(7):4558-4565. https://doi.org/10.3390/curroncol29070360

Qin F., Huang Z., Dong Q., Xu X., Lü T., Chen J.et al.. Stereotactic biopsy for lesions in the brainstem and deep brain: a single-center experience of 72 cases. Brazilian Journal of Medical and Biological Research 2021;54(8). https://doi.org/10.1590/1414-431x2021e11335

Enders F., Rothfuss A., Brehmer S., Stallkamp J., Schulte D., & Hänggi D. Optimized intraoperative imaging for stereotactic planning with a multiaxial robotic C-arm system: technical note and case series. Journal of Neurological Surgery Part a Central European Neurosurgery 2021;83(06):588-595. https://doi.org/10.1055/s-0041-1731754

Taweesomboonyat C., Tunthanathip T., Sae-heng S., & Oearsakul T. Diagnostic yield and complications of frameless stereotactic brain biopsy. Journal of Neurosciences in Rural Practice 2019;10(01):78-84. https://doi.org/10.4103/jnrp.jnrp_166_18

Bonaventura R., Montano N., Giordano M., Gessi M., Gaudino S., Izzo A., et al. Reassessing the role of brain tumor biopsy in the era of advanced surgical, molecular, and imaging techniques—a single-center experience with long-term follow-up. Journal of Personalized Medicine 2021;11(9):909. https://doi.org/10.3390/jpm11090909

Dellaretti M., Câmara B., Ferreira P., Júnior J., & Arantes R. Impact of histological diagnosis on the treatment of atypical brainstem lesions. Scientific Reports 2020;10(1). https://doi.org/10.1038/s41598-020-68063-6

Gupta M., Chan T., Santiago-Dieppa D., Yekula A., Sanchez C., Elster J.et al.. Robot-assisted stereotactic biopsy of pediatric brainstem and thalamic lesions. Journal of Neurosurgery Pediatrics 2021;27(3):317-324. https://doi.org/10.3171/2020.7.peds20373

Kalhoro A. and Hashim A. Framed stereotactic brain biopsy outcome – single center study. Pakistan Journal of Neurological Surgery 2020;24(2). https://doi.org/10.36552/pjns.v24i2.452

Kalhoro A., Rajper S., Saleem A., & Hashim A. Multimodality treatment of craniopharyngioma: aspiration of cystic contents and placement of Ommaya reservoir stereotactically followed by gamma knife radiosurgery – single center study of 81 cases. Pakistan Journal of Neurological Surgery 2020;24(2). https://doi.org/10.36552/pjns.v24i2.446

Navarro-Olvera J., Aguado-Carrillo G., Vintimilla-Sarmiento J., Parra-Romero G., Guartazaca-Guerrero M., & Carrillo-Ruiz J. Concordancia y rendimiento diagnóstico de biopsias estereotáxicas para fosa posterior: técnica y experiencia en un hospital de referencia. Cirugía Y Cirujanos 2022;90(4). https://doi.org/10.24875/ciru.21000237

Shareef R. and Ahmad S. Comparison of the accuracy of frameless stereotactic system (neuronavigation) against frame-based stereotaxy in deep-seated lesions of the brain. MJSP 2022;3(2):10-13. https://doi.org/10.61581/mjsp.vol03/02/03

Lau B., Vijian K., Liew D., & Wong A. Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series. Neurosurgical Review 2021;45(2):1473-1480. https://doi.org/10.1007/s10143-021-01671-6

Kesserwan M., Shakil H., Lannon M., McGinn R., Banfield L., Nath S.et al.. Frame-based versus frameless stereotactic brain biopsies: a systematic review and meta-analysis. Surgical Neurology International 2021;12:52. https://doi.org/10.25259/sni_824_2020

Neumann J., Campos B., Younes B., Jakobs M., Jungk C., Beynon C.et al.. Frame-based stereotactic biopsies using an intraoperative MR scanner are as safe and effective as conventional stereotactic procedures. Plos One 2018;13(10):e0205772. https://doi.org/10.1371/journal.pone.0205772

Bishokarma S., Shrestha P., Koirala S., Raut M., & Gongal D. Venture in 101 cranial punctures: a comparative study between frame-based versus frameless biopsy of 101 intracranial space-occupying lesions. Asian Journal of Neurosurgery 2019;14(01):175-180. https://doi.org/10.4103/ajns.ajns_137_18

Sciortino T., Fernandes B., Nibali M., Gay L., Rossi M., Lopci E.et al.. Frameless stereotactic biopsy for precision neurosurgery: diagnostic value, safety, and accuracy. Acta Neurochirurgica 2019;161(5):967-974. https://doi.org/10.1007/s00701-019-03873-w

He Z., Zhu C., Chan D., Cheung T., Ng H., Mok V.et al.. Diagnostic accuracy and field for improvement of frameless stereotactic brain biopsy: a focus on nondiagnostic cases. Journal of Neurological Surgery Part a Central European Neurosurgery 2022;85(01):048-061. https://doi.org/10.1055/a-1994-8033

Saß B., Pojskić M., Bopp M., Nimsky C., & Carl B.. Comparing fiducial-based and intraoperative computed tomography-based registration for frameless stereotactic brain biopsy. Stereotactic and Functional Neurosurgery 2020;99(1):79-89. https://doi.org/10.1159/000510007

Hu Y., Cai P., Zhang H., Aihemaitiniyazi A., Peng J., Li Y.et al.. A comparison between frame-based and robot-assisted stereotactic biopsy. Frontiers in Neurology 2022;13. https://doi.org/10.3389/fneur.2022.928070

Gutmann S., Tästensen C., Böttcher I., Dietzel J., Loderstedt S., Kohl S.et al. Clinical use of a new frameless optical neuronavigation system for brain biopsies: 10 cases (2013–2020). Journal of Small Animal Practice 2022;63(6):468-481. https://doi.org/10.1111/jsap.13482

Tu P., Liu Z., Chen C., Lin W., Bowes A., Lu C.et al.. Indirect targeting of subthalamic deep brain stimulation guided by stereotactic computed tomography and microelectrode recordings in patients with parkinson's disease. Frontiers in Human Neuroscience 2018;12. https://doi.org/10.3389/fnhum.2018.00470

Marcus H., Vakharia V., Ourselin S., Duncan J., Tisdall M., & Aquilina K. Robot-assisted stereotactic brain biopsy: systematic review and bibliometric analysis. Child S Nervous System 2018;34(7):1299-1309. https://doi.org/10.1007/s00381-018-3821-y

Bishokarma S., Shrestha S., Napit M., & Gongal D. Clinical experience with frame-based stereotactic biopsy for intracranial space-occupying lesions. Journal of Nepal Medical Association 2018;56(212):749-753. https://doi.org/10.31729/jnma.3665.