SURG-78. Day case frameless stereotactic biopsy in neuro-oncology: an 11-year experience in a UK tertiary centre

Abstract Previous evidence has demonstrated feasibility of day-case biopsy in selected neuro-oncology cohorts, but its widespread application has not yet occurred. There is potential for rationalising care pathways and finite healthcare resources. We present our 11-year experience of day-case frameless stereotactic biopsy without intra-operative frozen section in an adult neuro-oncology practice. Single centre retrospective study of stereotactic biopsies in adult neuro-oncology patients between January 2014-December 2024. Patient demographics, performance status (PS), radiological, operative, histological and outcome data were collected. Univariate analysis was performed to identify predictors of post-procedural intracranial haemorrhage (ICH) and unsuccessful same day discharge. Inpatient biopsy was performed if time-sensitive and non-dischargeable. Of 715 stereotactic biopsies, 559 (78.2%) were planned day-case procedures. Of the day-case cohort, median age was 65 years, with a male preponderance (329/559; 58.9%) and PS 0-1 (345; 79.6%). Majority of tumours were multifocal (359/559; 64.2%), of which 37.6% (135/359) were multicentric. Midline involvement was observed in 237/559 (42.4%). Median operative time was 30 minutes and 525/559 (93.9%) were performed under conscious sedation. Same day discharge was achieved in 92% (514/559) and a non-diagnostic biopsy in 2.7% (15/559). Post-procedure ICH was observed in 13.1% (73/559), of which 5 were symptomatic (0.89%). All cause 30-day readmission and mortality rates were 9.6% (54/559) and 0.89% (5/559) respectively. Univariate logistic regression was performed to identify factors associated with higher odds of unsuccessful same day discharge or ICH. No statistically significant factors were identified related to demographic, radiological or histological variables. Increased operative time was associated with higher odds of ICH (OR=1.02, p=0.045). Awake day-case biopsy across a wide range of neuro-oncology patients is feasible with an acceptable safety profile and diagnostic yield. We demonstrate that day-case awake frameless biopsy has treatment equipoise to inpatient pathways. Early discharge has additional economic and quality of life considerations in life limiting condition.