Robotic versus frame-based stereotactic biopsy in the diagnostics of focal brain lesions: a retrospective comparative study

For a long time, stereotactic brain biopsies have been an essential tool for establishing 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. The aim of this study was 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. We retrospectively analyzed 182 patients who underwent brain biopsies in the course of diagnostic evaluation of focal intracranial lesions, with special attention to duration of the procedure (total procedural time, total operating room (OR) time), procedural complications and diagnostic yield of the obtained material (nondiagnostic biopsy, trajectory error). The classification of neurosurgical complications proposed by Landriel Ibañez FA et al. was additionally applied. RA biopsy was performed with the ROSA ONE® Brain System (Zimmer Biomet Inc., Warsaw, IN, USA). The 182 patients underwent a total of 191 brain biopsies, including 52 RA, and 139 MG procedures. The median total procedural time was significantly shorter in the RA group (85 (69–151) min vs. 140 (120–165) min; p < 0.001), but the difference was no longer reflected in total OR times (85 (69–151) vs. 100 (88–118); p = 0.266). Likewise, there were no statistically significant differences in terms of nondiagnostic biopsy rate (9.62% vs. 11.51%; p = 0.709), trajectory error (5.77% vs. 3.60%; p = 0.686) and the overall complication rate (15.38% vs. 24.46%; p = 0.189). RA stereotactic biopsy is a reasonable alternative to MG, with no significant differences in efficacy and safety profile but remarkably shorter procedural time.