Improving Diagnostic Yield and Accuracy of Stereotactic Biopsies through Changes in Practice and Techniques: An 8-Year Single-Center Comparative Study

<b>Background</b> Stereotactic biopsies are used to aid neurosurgeons in clinching the diagnosis of intracranial lesions that are difficult to access surgically. A published study of stereotactic biopsies in our center demonstrated a diagnostic yield of only 76% for biopsies from the year 2014 to 2019. A set of criteria/prerequisites was applied to increase yield. <b>Objective</b> The aim of the study was to identify the improvement in accuracy and yield after implementation of a set of criteria/prerequisites. <b>Materials and Methods</b> This was a retrospective and prospective analysis of all patients who underwent stereotactic biopsies from the year 2014 to 2022. This study was conducted at Sarawak General Hospital, Malaysia. A set of stereotactic criteria/prerequisites was introduced since 2020, which include preoperative careful, meticulous trajectory planning and target selection, regular checking and maintenance of equipment, larger burr holes, and good sampling techniques. <b>Results</b> A total of 83 patients underwent stereotactic biopsies from the year 2014 to 2022. Frameless and frame-based methods were used for 45 (54%) and 38 (46%) patients, respectively. The overall diagnostic yield of all biopsies was 84%. Fifty patients underwent stereotactic biopsies prior to implementation of good practice guidelines in 2020 with a positive histopathological yield and accuracy of 76 and 88%, respectively. Thirty-three biopsies done postimplementation demonstrated a yield and accuracy of 97% ( <i>p</i> < 0.05). There was also a shift of preference toward frame-based methods after 2019, with 85% of these biopsies being frame based. <b>Conclusion</b> This comparative study shows that adherence to specific stereotactic biopsy guidelines and techniques introduced in our center has successfully improved our biopsy yield and accuracy.