Usefulness of Frameless Neuronavigation-Guided Stereotactic Biopsy for Brain Lesions Under Local Anesthesia: Surgical Outcomes and Feasibility for Molecular Diagnosis-Case Series.

BACKGROUND AND

OBJECTIVES

Frameless neuronavigation-guided stereotactic biopsy (SB) is a common surgical technique for diagnosing intracranial lesions. A frameless SB is generally performed under general anesthesia; however, no reports are available on the efficacy and safety of frameless SBs under local anesthesia (LA). This study reports the surgical outcomes, diagnostic yield, and feasibility of molecular analyses after performing a frameless SB under LA (SB-LA).

METHODS

The study retrospectively included patients who underwent a frameless SB-LA at our institute between March 2015 and January 2024. The clinical characteristics, intraoperative findings, completion rate of surgical procedure, complications, diagnostic yield, and feasibility of molecular analysis were analyzed retrospectively.

RESULTS

The study included 80 patients. Surgical procedures were completed in 79 patients (98.7%); the diagnosis was confirmed in 76 cases (95.0%). The diagnoses included diffuse gliomas (n = 38, 47.5%), primary central nervous system lymphomas (PCNSL; n = 27, 33.8%), other brain tumors (n = 4, 5.0%), demyelinating diseases (n = 2, 2.5%), and normal brain/gliosis (n = 5, 6.3%). All samples were sufficient for basic molecular analyses of isocitrate dehydrogenase 1/2, telomerase reverse transcriptase promoter, H3 histone family 3A, serine/threonine kinase B-RAF, and O-6-methylguanine deoxyribonucleic acid methyltransferase promoter methylation in gliomas and myeloid differentiation primary response gene 88 for PCNSLs. A comprehensive genomic profiling test using next-generation sequencing was attempted in 9 cases and was feasible in 8. Asymptomatic hemorrhages occurred in 14 patients (17.5%); no symptomatic hemorrhage occurred. Neurological deficits were observed in 1 patient (1.3%) who developed symptomatic small cerebral infarction. The median period from the first visit to our hospital to surgery was 3 days (range 0-12) for PCNSL and 6.5 days (range 0-21) for primary glioblastoma, isocitrate dehydrogenase wild-type.

CONCLUSION

Frameless SB-LAs can be performed safely with a high diagnostic yield and feasibility for molecular analysis. Frameless SB-LAs improve early diagnoses and therapeutic interventions without compromising molecular information.