Diagnostic yield and safety of frame-based versus robot-assisted stereotactic brain biopsy: a matched cohort analysis

Comprehensive Summary

This study by Mallereau et al. examines whether robot-assisted stereotactic brain biopsy can be performed accurately and safely as an alternative for intracranial lesions. A bicentric matched-cohort analysis of adult patients who underwent a stereotactic brain biopsy between 2011 and 2019 was conducted by matching robot-assisted cases to frame-based cases based on lesion and patient characteristics. Diagnostic yield and complication rates were predefined as the main outcomes and analyzed using statistical matching to reduce selection bias. The study found that the diagnostic yields were 97.4% identical for both techniques, with a low non-diagnostic biopsy rate of 2.6% in each group. Symptomatic temporary complications occurred more often in the robot-assisted group (6.5%) than in the frame-based group (2.8%), although the more severe complications, like permanent neurological deficits or mortality, didn’t differ significantly. Rates of symptomatic hemorrhage, infection, seizures, and death were low across both techniques. The findings showed that the diagnostic efficacy of both approaches is equivalent and that the differences are mainly limited to transient complications. Both techniques maintained favorable safety profiles and the increase in transient symptoms for robotic biopsies didn’t equate to worse long-term outcomes.

Outcomes and Implications

This research provides a comparison of stereotactic brain biopsies and offers evidence to guide procedural choices in neurosurgical practices. It supports the use of frame-based and robot-assisted biopsies, which are essential for diagnosing and molecular characterization of intracranial lesions, reassuring clinicians that adopting robotic systems doesn’t compromise the diagnostic yield. Centers considering investing in robotic platforms heavily benefit from these findings, as they clarify that these benefits relate to greater workflow flexibility and access to challenging anatomical targets. These results show that this practice can be immediately applied in clinical settings.