Drapeless Stereotactic Brain BIopsy Technique

Introduction: Percutaneous biopsy is a long-standing minimally invasive procedure used to collect tissue samples from the body to diagnose or monitor disease. The frameless stereotactic technique used for brain lesion biopsy is an established method for collecting tissue with minimal risk to patients. At many institutions, it is performed using a full sterile drape and skin preparation similar to an open craniotomy. Here we present our experiences with a modified stereotactic brain biopsy protocol in which surgeons use a 70% isopropyl alcohol spray without draping rather than establishing a full sterilely prepared and draped surgical field.

Methods: Institutional IRB reviewed the study protocol. From electronic health records dating February 2015 to August 2022, we retrospectively identified 204 patients who underwent frameless stereotactic brain biopsy with the drapeless spray technique using neuronavigation and a neuronavigation-guided flexible biopsy arm at a single institution. Of these, 182 had available follow-up care to a minimum of 30 days. Postoperative complications were collected from hospital records and office visit notes, including new neurologic deficits, procedural hemorrhage, or surgical site infection.

Results: Of 182 patients who met criteria: 0/182 (0%) were identified as acquiring new surgical site infection. 1/182 (0.5%) was identified as having a new neurologic deficit manifesting facial/throat weakness. Additionally, 1/182 (0.5%) had post-operative hemorrhage requiring surgical intervention. The rate of achieving tissue diagnosis was 170/182 (93.4%).

Conclusion : This study found no evidence of surgical site infection with a drapeless spray technique. In all, the rate of hemorrhagic or neurologic complications was low and comparable to other series, with similar high rates of successful biopsy. This study demonstrates that a drapeless spray technique can potentially save the time and cost of a full cranial drape and preparation without increasing infection rates, thereby reducing valuable operative room time utilization, resource cost and potentially increasing accuracy by minimizing manipulation of the biopsy or navigation arms.