Abstract
Introduction: Stereotactic brain biopsy is a routine procedure used to evaluate brain pathologies. Knowledge of histological diagnosis is crucial for further management in the majority of cases.
In this paper we present our 5-year experience with Varioguide frameless stereotactic system. Material and methods: Between 2010 and 2014, we treated 97 patients, 54 males and 43 females.
Mean age was 61 +- 14 years. Stereobiopsies were performed using trajectories planned on IPlan application based on MRI navigation sequences.
Primary outcome was diagnostic yield and rate of severe haemorrhagic complications. Results: We performed two procedures in four patients, thus we performed 101 procedures together.
Median volume of lesion was 18.8 cm3, IQR (interquartile range) 4.6-32 cm3. Lesion volume below 1 cm3 was found in 10 cases.
The biopsy was non-diagnostic in eight patients. Out of the 10 less than 1 cm3 lesions, biopsy was non-diagnostic in three cases, significantly more frequently than in larger lesions (p = 0.031).
A haemorrhagic complication was encountered in eight cases, bleeding was symptomatic in four. Severe morbidity and mortality was thus 4%.
On the day of surgery, a therapeutic dose of LMWH was administered in 10 cases, three of these suffered from post-op haemorrhage (p = 0.031). Conclusions: Frameless stereobiopsy using Varioguide system is a safe and effective system for brain biopsies.
Diagnostic yield was 92%. The only identified predictor of diagnostic yield was lesion volume above 1 cm3.
A therapeutic dose of LMWH on the day of surgery seems to be linked to higher incidence of haemorrhagic complications.