Advances, technological innovations, and future prospects in stereotactic brain biopsies

Abstract

Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients’ management algorithms based on early discharge after biopsy optimize the patient’s personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients’ postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.

Novel application of robot-guided stereotactic technique on biopsy diagnosis of intracranial lesions

“…However, other studies have shown that lesion size is not relevant to the diagnostic result (10,20). Our experience using the REMEBOT and CAS-R-2 compared with the ROSA showed differences in the mean lesion volume of ≤l cm 3 . In general, using bone nail-based marking and auto-registration methods for deep and small lesions is recommended to reduce systematic errors (17,20,22).…”

“…In particular, stereotactic biopsy can be used for multiple lesions; for difficult craniotomy; in high-risk locations such as the suprasellar, pineal, and brainstem regions; and in patients who cannot tolerate surgery because of poor health. With the rapid progress in neuroimaging, neurosurgical navigation technology, and especially the application of neurosurgical robots, stereotactic biopsy techniques for intracranial lesions have been rapidly developed with high visualization, automation, and precision (1)(2)(3). Although some researchers have concluded that stereotactic brain biopsy is feasible and safe, few have focused on diverse robotic systems applied in vivo (1,4).…”

Combination of Tractography, Intraoperative Computed Tomography and 5-Aminolevulinic Acid Fluorescence in Stereotactic Brain Biopsies: A Case Series

“…Stereotactic needle biopsy is a surgical technique frequently applied to collect diagnostic tissue from deep seated tumors [1] in order to define the nature of an abnormal signal discovered on diagnostic imaging. Two main methods have been developed over the years in order to maximize the safety, precision and reliability of this procedure, both based on pre-operative imaging (MRI, CT) [2]: the frame-based and the frameless technique.…”

“…Photodynamic diagnosis using 5-ALA was first introduced in stereotactic biopsies by Yamaguchi et al as a rapid and effective method to confirm the presence of tumoral tissue in biopsy samples [17]. Since then, it has become a possible tool, in association with intra-operative pathology, to improve the diagnostic yield of brain biopsies with interesting results [1,[18][19][20][21][22][23][24].…”