title: Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques.
abstract: 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 2000-2008. 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 (6.6%). 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). Intraoperative MRI-guided brain biopsy is associated with fewer serious adverse events and shorter hospital stay.
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: ylu4@partners.org.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Cecil
authors.initials: C
authors.lastname: Yeung
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Radmanesh
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wiemann
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Black
authors.affiliation: Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008136:Longevity; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011237:Predictive Value of Tests; D012737:Sex Factors; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*
keywords: Brain biopsy; Frame-based; Frameless stereotactic; Intraoperative MRI
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