Efficacy of Frameless Stereotactic-Guided Brain Lesion Biopsies in a Referral Hospital of the Brazilian Public Health System

Abstract Frameless biopsy (FLB) is a procedure to obtain samples of brain lesions. The available studies indicate that its rate is lower when compared to frame-based stereotaxic procedures. To demonstrate FLB's accuracy for intracranial lesions and to evaluate the noncontrast computed tomography (NCCT) in relation to the biopsied target in the immediate postoperative period. Also, to compare efficacy and complication data with frame-based biopsies. A total of 50 patients who underwent FLB at Santa Casa de Misericórdia de Belo Horizonte (SCMBH) between 2022 and 2023 were included. Evaluation of postoperative NCCT scans was performed by three independent neuroradiologists. The complications rate was 4 (8%), including 1 case of permanent neurological deficit, 2 cases of symptomatic hemorrhage with transient motor deficit, and 1 case of cerebral edema progressing to death. Furthermore, 46 (92%) patients were diagnosed, and the diagnosis rate correlated with lesion diameter and number of fragments (p = 0.02 and 0.03, respectively). Radiological evaluation of postoperative NCCT scans revealed a concordance rate of 84 and 86% between the planned biopsy target and the real site of tissue collection. There was a high level of agreement between the neuroradiologists' analyses (kappa: 0.76–0.84). Compared to the frame-based group, the analyses yielded significant correlation between biopsy technique and gender (p = 0.01). The present study demonstrates that FLB technique is effective and safe for biopsies of intracranial lesions, presenting similar efficacy and safety to stereotactic biopsy. Additionally, the NCCT proved to be a good method to assess biopsy agreement.