Comparative Effectiveness of Frame-Based, Frameless, and Intraoperative Magnetic Resonance Imaginge-Guided Brain Biopsy Techniques

OBJECTIVE: To compare the diagnostic yield and safety profiles of intraoperative magnetic resonance imaging (MRI) guided needle brain biopsy with 2 traditional brain biopsy methods :frame-based and frameless stereotactic brain biopsy. METHODS: A retrospective analysis was performed of 288 consecutive needle brain biopsies in 277 patients undergoing stereotactic brain biopsy with any of the 3 biopsy methods at Brigham and Women's Hospital from 200(1 -2008. Variables including age, sex, history of radiation and previous surgery, pathology results, complications, and postoperative length of hospital stay were analyzed. RESULTS: Over the course of 8 years, 288 brain biopsies were performed. Of these, 253 (87.8%) biopsies yielded positive diagnostic tissue. Young age (<40 years old) and history of brain radiation or surgery were significant negative predictors for a positive biopsy diagnostic yield. Excluding patients with prior radiation or surgeries, no significant difference in diagnostic yield was detected among the 3 groups, with frame based biopsies yielding 96.9%, frameless biopsies yielding 91.8%, and intraoperative MRI guided needle biopsies yielding 89.9% positive diagnostic yield, Serious adverse events occurred 19 biopsies 16,6%), Intraoperative MRI guided brain biopsies were associated with less serious adverse events and the shortest postoperative hospital stay. CONCLUSIONS: Frame-based, frameless stereotactic, and intraoperative MRI guided brain needle biopsy techniques have comparable diagnostic yield for patients with no prior treatments (either radiation or surgery). lntraoperative MRI guided brain biopsy is associated with fewer serious adverse events and shorter hospital stay.