Effect of training on navigated frameless and frame-based stereotactic brain biopsies: a retrospective comparison of staff neurosurgeon and trainee perioperative performance and complications

Resident physicians should be integrated early into a broad spectrum of surgical procedures during postgraduate training. At the same time, medical standards must be maintained and patient safety ensured. This study investigates whether resident involvement in stereotactic brain biopsy affects perioperative performance and complications.

This retrospective, two-center study compared 217 consecutive patients undergoing navigated frameless and frame-based stereotactic brain biopsies performed either by a supervised neurosurgery resident (teaching cases) or by a BCFN (non-teaching cases). The primary endpoint was the occurrence of a complication. Operation and anesthesia time as well as hospitalization length served as secondary endpoints. Categorical data were analyzed using Pearson’s chi-square and Fisher test, and continuous data using the Mann–Whitney U Test.

A total of 217 biopsies were stratified into n = 60 (27.6%) teaching cases and n = 157 (72.4%) non-teaching cases. Complication rates (asymptomatic hemorrhages) were comparable with 1/60 (1.7%) for resident-performed cases and 3/157 (1.9%) for BCFN cases. Mean operation time for navigated stereotactic biopsies was 38.1 ± 14.8 min for residents and 44.7 ± 22.6 min for BCFNs (p = 0.133). For frame-based biopsies, mean operation time performed by residents was 47.5 ± 32 min and 32.9 ± 9.9 min for BCFNs (p = 0.047). Anesthesia time for navigated biopsies was 119.2 ± 39.6 min for residents and 124.7 ± 27.9 min for BCFNs (p = 0.049). For frame-based biopsies, anesthesia time was 164.5 ± 98 min for residents and 111.8 ± 28.4 min for BCFNs (p < 0.01). Residents completed frameless biopsies faster than frame-based ones in terms of anesthesia time (p < 0.01) whereas BCFN were faster with frame-based procedures (operative time (p < 0.01) and anesthesia time (p < 0.01)). Mean hospitalization time was significantly longer in the BCFN group with 12.5 ± 15 vs. 7.52 ± 8.8 days (p = 0.015). There was no significant correlation between neurosurgical residents' year of training and the above parameters.

The study supports the safety of supervised early surgical education for stereotactic brain biopsies. Residents require significantly more time for frame-based cases than BCFN, but complication rates remain comparable.