title: Yield and complications of frame-based and frameless stereotactic brain biopsy--the value of intra-operative histological analysis.
abstract: OBJECTIVE
  Image-guided brain biopsy is an established method to obtain histopathological diagnosis and guide management for cerebral lesions. The study aimed to establish negative biopsy and symptomatic haemorrhage rates at a single centre, and to assess the influence of factors such as lesion location, final pathology and the use of intra-operative smears.
  
  
  METHODS
  A retrospective analysis of all frame-based and frameless stereotactic biopsies carried out over 57 months from July 2006 to March 2011.
  
  
  RESULTS
  A total of 351 biopsies were undertaken, 256 frame-based (73%) and 95 frameless (27%). Mean age was 57 years (range 18-87). Negative biopsy rate was 5.1%. There was a significantly greater negative biopsy rate in deep brain biopsies (p = 0.011) and in the cerebellum (p < 0.001). Intra-operative smear significantly reduced negative biopsy rates from 11.1% to 3.7% (p = 0.011). If repeat smear was requested, yet not provided, then the negative biopsy rate was 57.1% (p = 0.0085). The overall symptomatic haemorrhage rate was 3.7%. There was a significant increase in haemorrhage rate in deep versus superficial biopsies (p = 0.023) and a significantly greater haemorrhage rate in lymphoma biopsies (p = 0.015). There was no significant increase in haemorrhage rate in high-grade compared with low-grade tumour biopsies. Mortality rates at 7 and 30 days post-operatively were 0.6% and 1.7%, respectively, with mortality after 7 days unrelated to biopsy.
  
  
  CONCLUSIONS
  We advocate intra-operative histopathological analysis to decrease negative biopsy rates and advise increased caution when undertaking biopsies of deep lesions or suspected lymphoma cases due to the potentially increased risk of haemorrhage.
authors.affiliation: Department of Neurosurgery, Oxford University Hospitals, John Radcliffe Hospital , Oxford , UK.
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Livermore
authors.forename: Ruichong
authors.initials: R
authors.lastname: Ma
authors.forename: Stana
authors.initials: S
authors.lastname: Bojanic
authors.forename: Erlick A C
authors.initials: EA
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000379:methods; D055815:Young Adult
keywords: brain biopsy; frameless; haemorrhage rate; intra-operative smear; lymphoma