Diagnostic Yield of Stereotactic Brain Biopsy in a Sub-Saharan Tertiary Center: A Comprehensive 10-Year Retrospective Analysis

Abstract

IntroductionStereotactic brain biopsy is a crucial minimally invasive surgical technique leveraged to obtain tissue specimens from deep-seated intracranial lesions, offering a safer alternative to open craniotomy for patients who cannot tolerate the latter. Despite its effectiveness, the diagnostic yield varies across different centres and has not been widely studied in Sub-Saharan Africa. MethodsA single-centre retrospective analysis was conducted on 67 consecutive stereotactic brain biopsy procedures carried out by experienced neurosurgeons between January 2012 and December 2022 at a tertiary centre in Sub-Saharan Africa. Preoperative clinical status, biopsy type, post-operative complication rate, and histological diagnosis were meticulously analysed. Factors associated with negative biopsy results were identified using IBM SPSS version for Mac, with Fisher's exact test employed to detect differences in patient characteristics. Statistical significance was pegged at P<0.05. ResultsThe overall diagnostic yield rate was 67%. Major contributors to negative biopsy outcomes were superficial location of the lesion, lesion size less than 10cc, and the use of the Cape Town Stereotactic System. Enhanced yield rates of up to 93% were realized through the application of MRI-based images, Stealth Station 7 and frozen section analysis. No correlation was observed between the number of cores obtained and the yield rate. Procedure complications were negligible, and no procedure-related mortality was recorded. ConclusionThe diagnostic yield rate from our study was somewhat lower than previously reported in contemporary literature, primarily attributed to the differing definitions of diagnostic yield, the dominant use of the older framed Cape Town Stereotactic system, CT-based imaging, and the absence of intraoperative frozen section. Nevertheless, biopsies conducted using the frameless system were comparable with studies from other global regions. Our findings reaffirm that stereotactic brain biopsy when complemented with MRI-based imaging, frameless stereotactic systems and intraoperative frozen section is a safe, effective, and reliable method for obtaining histological diagnosis.