title: Diagnostic yield and morbidity by neuronavigation-guided frameless stereotactic biopsy using magnetic resonance imaging and by frame-based computed tomography-guided stereotactic biopsy.
abstract: BACKGROUND
  We compared the diagnostic yield and morbidity by frame-based computed tomography-guided stereotactic biopsy (CTSTB) with Brown-Roberts-Wells (BRW) unit and by neuronavigation-guided frameless stereotactic biopsy (NSTB) using magnetic resonance imaging (MRI).
  
  
  METHODS
  The subjects' age range was 15-83 years. CTSTB with BRW unit was performed for 59 tumors (58 cases, 1988-2007). NSTB was performed for 38 tumors (35 cases, 2007-2013) with the needle sheath attached to the head holder. By NSTB, target locations of sampling points and trajectories were confirmed by using MRI. Diffusion tensor imaging-based fiber tractography was used to achieve safe trajectories. STB by using BRW did not visualize the trajectory virtually; however, the planning images for NSTB were able to show the trajectory virtually before the procedure.
  
  
  RESULTS
  Histological diagnoses were established for 93 tumors at the first biopsy. The diagnostic yield was 94.9% by CTSTB and 97.4% by NSTB (P = 0.944). The morbidity rate was 5.1% by CTSTB and 0% by NSTB (P = 0.417). The absolute risk reduction was 23.1% by NSTB when the targets were basal ganglia (putamen, globus pallidus) or thalamus. In the cases of glioma for which the targets were basal ganglia (putamen, globus pallidus) or thalamus, the absolute risk reduction by NSTB was 30%.
  
  
  CONCLUSIONS
  There was no significant difference between CTSTB and NSTB concerning the diagnostic yield and morbidity. However, when the target is the basal ganglia (putamen, globus pallidus) or thalamus and glioma is suspected, NSTB by using MRI with virtual trajectory is preferable to CTSTB concerning morbidity.
authors.affiliation: Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nishihara
authors.affiliation: Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Takeda
authors.affiliation: Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Harada
authors.affiliation: Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Kidoguchi
authors.affiliation: Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
authors.forename: Shoutarou
authors.initials: S
authors.lastname: Tatsumi
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasayama
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
keywords: Brain tumor; neuronavigation; stereotactic biopsy