title: Contemporary frameless intracranial biopsy techniques: Might variation in safety and efficacy be expected?
abstract: BACKGROUND
  Frameless stereotactic neuronavigation has proven to be a feasible technology to acquire brain biopsies with good accuracy and little morbidity and mortality. New systems are constantly introduced into the neurosurgical armamentarium, although few studies have actually evaluated and compared the diagnostic yield, morbidity, and mortality of various manufacturer's frameless neuronavigation systems. The present study reports our experience with brain biopsy procedures performed using both the Medtronic Stealth Treon(TM) Vertek® and BrainLAB® Varioguide frameless stereotactic brain biopsy systems.
  
  
  METHODS
  All 247 consecutive biopsies from January 2008 until May 2013 were evaluated retrospectively. One hundred two biopsies each were performed using the Medtronic (2008-2009) and BrainLAB® system (2011-2013), respectively. The year 2010 was considered a transition year, in which 43 biopsies were performed with either system. Patient demographics, perioperative characteristics, and histological diagnosis were reviewed, and a comparison was made between the two brain biopsy systems.
  
  
  RESULTS
  The overall diagnostic yield was 94.6 %, i.e., 11 biopsies were nondiagnostic, 5 (4.9 %) with the Medtronic and 6 (5.9 %) with the BrainLAB® system. No differences besides the operating time (108 vs 120 min) were found between the two biopsy methods. On average, 6.6 tissue samples were taken with either technique. Peri- and postoperative complications were seen in 5.3 % and 12.9 %, consisting of three symptomatic hemorrhages (1.2 %). Biopsy-related mortality occurred in 0.8 % of all biopsies.
  
  
  CONCLUSIONS
  Regarding diagnostic yield, complication rate, and biopsy-related mortality, there seems to be no difference between the frameless biopsy technique from Medtronic and BrainLAB®. In contemporary time, the neurosurgeon has many tools to choose from, all with a relatively fast learning curve and ever improving feasibility. Thus, the issue of choice involves not the results, but the familiarity, end-user friendliness, and overall comfort when operating the system.
authors: Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, 's Gravendijkwal 230, Kamer H-703, 3015, CE, Rotterdam, The Netherlands.
authors: Iris S C
authors: IS
authors: Verploegh
authors: Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, 's Gravendijkwal 230, Kamer H-703, 3015, CE, Rotterdam, The Netherlands. v.volovici@erasmusmc.nl.
authors: Victor
authors: V
authors: Volovici
authors: Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, 's Gravendijkwal 230, Kamer H-703, 3015, CE, Rotterdam, The Netherlands.
authors: Iain K
authors: IK
authors: Haitsma
authors: Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, 's Gravendijkwal 230, Kamer H-703, 3015, CE, Rotterdam, The Netherlands.
authors: Joost W
authors: JW
authors: Schouten
authors: Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, 's Gravendijkwal 230, Kamer H-703, 3015, CE, Rotterdam, The Netherlands.
authors: Clemens M
authors: CM
authors: Dirven
authors: Department of Pathology, Brain Tumor Center, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Johan M
authors: JM
authors: Kros
authors: Department of Neurosurgery, Brain Tumor Center, Erasmus Medical Center, 's Gravendijkwal 230, Kamer H-703, 3015, CE, Rotterdam, The Netherlands.
authors: Ruben
authors: R
authors: Dammers
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*
keywords: Biopsy; Brain tumor; Frameless stereotaxy; Stealth; Varioguide