Voxel-basierte Analyse des Blutungsrisikos nach stereotaktischen und robotergestützten Hirnbiopsien

Glioma therapy is increasingly guided by molecular characteristics of the tumor, emphasizing the evolving significance of brain biopsies. At the same time, there is an increasing application of robotic technology in acquiring tumor samples reducing invasiveness and surgical time. Nevertheless, hemorrhages remain a major concern. This study aimed to understand risk factors for hemorrhage and differences between surgical techniques from a large cohort undergoing stereotactic and robotic needle biopsies.

We analyzed 345 frame-based (FRAME, n=177) and robotic (ROBOT, n=168) trajectories in 327 patients undergoing stereotactic biopsy in a 10 years period. Patients" preoperative MR and postoperative CT imaging were registered and normalized to the standard MNI space enabling standardized volumetry of postoperative hemorrhage and inter-subject comparison of bleeding location. Additionally, we analyzed skin-to-skin time (STS), the surgical approach (burr hole and twist drill), diagnostic yield (DY) and permanent morbidity (PM) in both groups.

After the integration of robotic technology, there was a significant shift to twist drill approaches (70.8% vs 14.7%) resulting in a significant STS reduction. Both techniques had a excellent DY (98.6% and 99.4%). Asymptomatic hemorrhages were detected on postoperative CT scans in 12.5%, however only 2.8% showed transient neurological deterioration. Permanent morbidity was detected in 1.8%. There were no differences in hemorrhage risk comparing stereotactic and robotic biopsies. Voxel-based analysis demonstrated a higher risk for deep-seated lesions within the basal ganglia and the thalamus. Hemorrhages occurred predominantly at the target (especially in high-grade glioma) and the cortical entry area. There were no significant differences in hemorrhages comparing stereotactic and robotic biopsies or different surgical approaches (burr hole and twist drill).

Both stereotactic and robotic brain biopsies are safe. While asymptomatic hemorrhages are quite common after brain biopsies, neurological deterioration is rare. Deep-seated location and high-grade gliomas are independent risk factors. The introduction of robotics modified the surgical approach decreasing duration and the invasiveness without affecting the diagnostic yield or the complication rate.