Stereotactic Biopsy Techniques for Intracranial Lesions

Stereotactic biopsy has become the cornerstone for obtaining tissue diagnosis from deep-seated or eloquent brain regions while minimising morbidity. Traditional frame-based systems rely on a rigid headframe and preoperative imaging to define a Cartesian co-ordinate system that guides needle insertion. Frameless neuronavigation techniques employ optical or electromagnetic tracking linked to MRI or CT data, offering greater patient comfort and flexible trajectories. More recently, patient-specific devices produced by three-dimensional printing have emerged to combine the accuracy of frame-based methods with simplified handling. Robotic platforms now complement both frame-based and frameless approaches, automating trajectory alignment and reducing manual error. Concurrent advances in intraoperative imaging, tractography, fluorescence guidance and rapid tissue assessment have further enhanced safety by avoiding critical vessels and ensuring viable tumour sampling. Across modalities, diagnostic yield consistently exceeds 90% while maintaining low rates of haemorrhage and neurological complication. The integration of serial biopsies, positron emission tomography guidance and real-time molecular profiling has elevated stereotactic biopsy from a purely histological tool to a linchpin of precision neuro-oncology.

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Stereotactic Biopsy Techniques for Intracranial Lesions publication trend

The graph below shows the total number of articles in stereotactic biopsy techniques for intracranial lesions across all publications each year (not limited to Nature Index journals).

Technical terms

Stereotactic frame: A rigid external device affixed to the skull to establish a fixed reference for biopsy trajectory planning.

Frameless neuronavigation: A tracking system using surface markers or sensors linked to preoperative imaging, permitting flexible instrument guidance without a rigid frame.

Robotic assistance: Automated or semi-automated robotic platforms that align and stabilise biopsy instruments according to planned trajectories.

Diagnostic yield: The percentage of procedures that obtain adequate tissue for definitive histological and molecular diagnosis.

Target accuracy: The distance between the intended biopsy target and the actual needle tip position, typically measured in millimetres.

Integrated diagnosis: A combined classification of tumour based on histopathology and molecular markers in accordance with contemporary WHO guidelines.

References

1. Contemporary frameless intracranial biopsy techniques: Might variation in safety and efficacy be expected?. Acta Neurochirurgica (2015).
2. ARISE—The Accuracy Evaluation of a Patient-Specific 3D-Printed Biopsy System Based on MRI Data: A Cadaveric Study. Bioengineering (2024).
3. Robot-assisted stereotactic brain biopsy: systematic review and bibliometric analysis. Child's Nervous System (2018).
4. Current Trends for Improving Safety of Stereotactic Brain Biopsies: Advanced Optical Methods for Vessel Avoidance and Tumor Detection. Frontiers in Oncology (2019).
5. Diagnostic Yield and Complication Rate of Stereotactic Biopsies in Precision Medicine of Gliomas. Frontiers in Neurology (2022).
6. A Comparation Between Frame-Based and Robot-Assisted in Stereotactic Biopsy. Frontiers in Neurology (2022).