Stereotactic Brain Biopsies Using Varioguide System – 101 Cases Experience

Authors: O. Bradáč;  A. Štekláčová;  F. Kramář;  V. Beneš
Authors‘ workplace: Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN – VFN Praha
Published in: Cesk Slov Neurol N 2016; 79/112(5): 579-584
Category: Short Communication
doi: 10.14735/amcsnn2016579


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.

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).

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.

Key words:
frameless stereotaxy – brain biopsy – MRI navigation – diagnostic yield

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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