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Background <p>Stereotactic brain biopsy (SBB) is a fundamental diagnostic procedure for intracranial lesions that are radiographically indeterminate or surgically inaccessible. While advances in navigation and perioperative care have enhanced safety, high-granularity data identifying independent predictors of diagnostic failure and complications in large longitudinal cohorts remain limited.</p> Methods <p>We retrospectively reviewed 725 adult patients (≥18 years) who underwent SBB at a tertiary academic center between 2014 and 2025. Primary outcomes included diagnostic yield and procedure-related complications, specifically postoperative hemorrhage. A 1:4 nearest-neighbor matched case-control design was used to assess predictors of non-diagnostic yield (<i>n</i> = 184) and postoperative hemorrhage (<i>n</i> = 95), controlling for age and temporal technological changes. Multivariate logistic regression was utilized to calculate odds ratios (OR) and 95% confidence intervals (CI).</p> Results <p>The overall diagnostic yield was 95.0% and the overall complication rate was 4.69%. Multivariate analysis revealed that low-yield pathology (e.g., low-grade glioma, inflammatory, or infectious lesions) was the sole independent predictor of a non-diagnostic result (OR 4.22, 95% CI 1.77–10.06, <i>p</i> = 0.001). Regarding surgical safety, deep-seated location was the only independent predictor of postoperative hemorrhage (OR 3.93, 95% CI 1.24–12.46, <i>p</i> = 0.019). Notably, no statistical differences in yield or safety were observed between robotic, frameless, and frame-based navigation platforms (<i>p</i> &gt; 0.80). Median LOS was 1&#xa0;day (mean 3.92 ± 5.23 days) and significantly declined over the study period (<i>p</i> = 0.023). Comparative analysis showed that LOS was identical between diagnostic and non-diagnostic groups.</p> Conclusions <p>Over a decade of institutional experience, SBB demonstrated high diagnostic accuracy and safety across all navigation platforms. These findings identify lesion biology as the primary driver of non-diagnostic sampling and deep-seated location as the chief risk factor for hemorrhage. The comparable hospital resource utilization regardless of diagnostic outcome, combined with a declining LOS, supports the feasibility of standardized early-discharge pathways in modern neuro-oncology.</p> Clinical trial number <p>Not applicable.</p>

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Predictors of diagnostic yield and surgical safety in stereotactic brain biopsy

  • 期刊论文

  • 发表日期：

    2026年4月17日

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  • Maged T. Ghoche,
  • Neslihan Nisa Gecici,
  • Kenji Miki,
  • Fanen Yuan,
  • Megan Mantica,
  • Pascal O. Zinn,
  • Kalil G. Abdullah

摘要

Background

Stereotactic brain biopsy (SBB) is a fundamental diagnostic procedure for intracranial lesions that are radiographically indeterminate or surgically inaccessible. While advances in navigation and perioperative care have enhanced safety, high-granularity data identifying independent predictors of diagnostic failure and complications in large longitudinal cohorts remain limited.

Methods

We retrospectively reviewed 725 adult patients (≥18 years) who underwent SBB at a tertiary academic center between 2014 and 2025. Primary outcomes included diagnostic yield and procedure-related complications, specifically postoperative hemorrhage. A 1:4 nearest-neighbor matched case-control design was used to assess predictors of non-diagnostic yield (n = 184) and postoperative hemorrhage (n = 95), controlling for age and temporal technological changes. Multivariate logistic regression was utilized to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results

The overall diagnostic yield was 95.0% and the overall complication rate was 4.69%. Multivariate analysis revealed that low-yield pathology (e.g., low-grade glioma, inflammatory, or infectious lesions) was the sole independent predictor of a non-diagnostic result (OR 4.22, 95% CI 1.77–10.06, p = 0.001). Regarding surgical safety, deep-seated location was the only independent predictor of postoperative hemorrhage (OR 3.93, 95% CI 1.24–12.46, p = 0.019). Notably, no statistical differences in yield or safety were observed between robotic, frameless, and frame-based navigation platforms (p > 0.80). Median LOS was 1 day (mean 3.92 ± 5.23 days) and significantly declined over the study period (p = 0.023). Comparative analysis showed that LOS was identical between diagnostic and non-diagnostic groups.

Conclusions

Over a decade of institutional experience, SBB demonstrated high diagnostic accuracy and safety across all navigation platforms. These findings identify lesion biology as the primary driver of non-diagnostic sampling and deep-seated location as the chief risk factor for hemorrhage. The comparable hospital resource utilization regardless of diagnostic outcome, combined with a declining LOS, supports the feasibility of standardized early-discharge pathways in modern neuro-oncology.

Clinical trial number

Not applicable.