Comparison of the Diagnostic Efficacy of Frameless Stereotactic Biopsy (Varioguide) with Other Methods Reported in the Literature: A Single-Center Experience.

OBJECTIVE

To evaluate the diagnostic yield, complication profile, and demographic and radiological factors associated with procedural success in intracranial biopsies performed using the VarioGuide frameless stereotactic system.

MATERIALS AND

METHODS

We retrospectively reviewed 58 consecutive patients who underwent VarioGuide-assisted frameless stereotactic brain biopsy between August 2018 and December 2025. All procedures were performed under general anesthesia using co-registered preoperative high-resolution computed tomography and magnetic resonance imaging datasets. The associations of age, sex, lesion volume, and contrast-enhancement pattern with diagnostic success and postoperative complications were evaluated using exploratory univariable analyses.

RESULTS

The cohort included 42 male (72.4%) and 16 female (27.6%) patients, with a mean age of 49.8±18.7 years. The diagnostic yield was 94.8% (55/58). The median age was 51 years (range, 6-79 years) among patients with diagnostic biopsies and 28 years (range, 2-41 years) among those with non-diagnostic biopsies (exact Mann-Whitney U test, p=0.020). Lesion volume (p=0.843), sex (p=0.181), and contrast-enhancement pattern (p>0.999) were not significantly associated with diagnostic success. Postoperative findings occurred in 10 patients (17.2%), including asymptomatic microhemorrhage in six (10.3%), pneumocephalus in two (3.4%), and symptomatic hematomas requiring surgical decompression in two (3.4%). Neither age (p=0.133) nor lesion volume (p=0.951) differed significantly according to complication status.

CONCLUSION

In this retrospective single-center series, VarioGuide-assisted frameless stereotactic biopsy provided a high diagnostic yield and a low rate of major procedure-related morbidity. Younger age was associated with a non-diagnostic biopsy in an exploratory analysis; however, this finding should be interpreted cautiously because only three biopsies were non-diagnostic.