Comparison of Robotic and Frame-based Stereotactic Biopsy in the Diagnostics of Focal Brain Lesions

Purpose For a long time, stereotactic brain biopsies have been an essential tool for establishing a treatment strategy, especially in deep-seated and compound lesions. With frame-based biopsy being the standard method, novel frameless robotic solutions are gradually entering mainstream use - potentially increasing diagnostic accuracy and precision. We aimed to compare the safety and efficacy of robot-assisted (RA) and frame-based manually-guided (MG) stereotactic biopsy in the diagnostics of focal brain lesions. Methods We conducted a retrospective analysis of 182 patients who underwent brain biopsy in the course of diagnostic evaluation of focal intracranial lesions, with special attention to duration of the procedure, procedural complications, diagnostic yield of the obtained material and type of diagnosed pathology. RA biopsy was performed with ROSA ONE® Brain System and MG with a RM or ZD stereotactic frame. Results The 182 patients underwent a total of 191 brain biopsies, including 52 cases of RA and 139 cases of MG. The mean total procedural duration was significantly shorter in the RA group (102.92 ± 57.86 min vs. 147.33 ± 34.93 min; p < 0.001). There were no statistically significant differences in terms of nondiagnostic biopsy rate (11.76% vs. 12.31%; p = 0.920), trajectory error (3.92% vs. 3.85%; p = 0.981) and the overall complication rate (15.69% vs. 24.64%; p = 0.189). Conclusion RA stereotactic biopsy is a reasonable alternative to MG, ensuring a comparable safety profile and diagnostic yield of the samples but with remarkably shorter procedural time.