Efficacy, Safety, and Duration of a Frameless Fiducial-Less Brain Biopsy versus Frame-based Stereotactic Biopsy: A Prospective Randomized Study

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We compared the efficacy, duration, safety, length of hospital stay of a frameless fiducial-less brain biopsy with those of the standard frame-based stereotactic biopsy.

Patients and Methods

This prospective cohort study enrolled 56 adult patients: (1) for whom no conclusive diagnosis could be reached noninvasively; (2a) who had lesions involving deep-seated and eloquent areas, multifocal lesions, or lesions for which craniotomy and lesion removal was not indicated, or (2b) were poor candidates for craniotomy (> 80 years of age and/or with serious comorbidities). Frameless and frame-based biopsy were performed in 28 patients each


A diagnosis was not made in four cases (14.3%) of the frame-based biopsy group and in three cases (10.7%) of the frameless biopsy group, in spite of accurate targeting (p = 1.0). The mean duration of the whole procedure (preparatory steps outside the operating room [OR], inside the OR, surgery) was 111.3 minutes for the frame-based biopsy and 79.1 minutes for the frameless biopsy (p = 0.001). No statistically significant differences between the two methods were found concerning new neurologic symptoms, new abnormal findings in postoperative computed tomography (CT) and length of postoperative hospital stay (LOS). The smallest diameter of a successfully biopsied lesion was 15 mm for both groups.


The frameless fiducial-less brain biopsy was equally efficacious and safe compared with the standard stereotactic frame-based biopsy. The overall duration of frameless biopsy is shorter than that of frame-based biopsy, mainly because the preparatory steps in frameless biopsy require less time. However, the overall time spent in the OR did not differ between the two groups. The LOS also did not differ significantly.

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