Robot-Assisted Stereotactic Biopsies in 377 Consecutive Adult Patients with Supratentorial Diffuse Gliomas: Diagnostic Yield, Safety, and Postoperative Outcomes

World Neurosurg. 2021 Apr:148:e301-e313. doi: 10.1016/j.wneu.2020.12.127. Epub 2021 Jan 4.

Abstract

Background: Multiple biopsy samples are warranted for the histomolecular diagnosis of diffuse gliomas in the current molecular era, which possibly increases morbidity.

Objective: We assessed diagnostic yield, safety, and risk factors of postoperative morbidity after robot-assisted serial stereotactic biopsy sampling along 1 biopsy trajectory for diffuse gliomas.

Methods: Observational retrospective analysis of consecutive magnetic resonance imaging-based robot-assisted stereotactic biopsies performed at a single institution to assess the diagnosis of nonresectable newly diagnosed supratentorial diffuse gliomas in adults (2006-2016).

Results: In 377 patients, 4.2 ± 1.9 biopsy samples were obtained at 2.6 ± 1.2 biopsy sites. The histopathologic diagnosis was obtained in 98.7% of cases. Preoperative neurologic deficit (P = 0.030), biopsy site hemorrhage ≥20 mm (P = 0.004), and increased mass effect on postoperative imaging (P = 0.014) were predictors of a new postoperative neurologic deficit (7.7%). Postoperative neurologic deficit (P < 0.001) and increased mass effect on postoperative imaging (P = 0.014) were predictors of a Karnofsky Performance Status decrease ≥20 points postoperatively (4.0%). Increased intracranial pressure preoperatively (P = 0.048) and volume of the contrast-enhanced area ≥13 cm3 (P = 0.048) were predictors of an increased mass effect on postoperative imaging (4.4%). Preoperative Karnofsky Performance Status <70 (P = 0.045) and increased mass effect on postoperative imaging (P < 0.001) were predictors of mortality 1 month postoperatively (2.9%). Preoperative neurologic deficit (P = 0.005), preoperative Karnofsky Performance Status <70 (P < 0.001), subventricular zone contact (P = 0.004), contrast enhancement (P = 0.018), and steroid use (P = 0.003), were predictors of the inability to discharge to home postoperatively (37.0%).

Conclusions: Robot-assisted stereotactic biopsy sampling results in high diagnostic accuracy with low complication rates. Multiple biopsy sites and samples do not increase postoperative complications.

Keywords: Glioma; Neuropathology; Patient discharge; Robotic surgical procedures; Stereotaxic techniques.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy / adverse effects
  • Biopsy / instrumentation
  • Biopsy / methods*
  • Female
  • Glioma / diagnosis
  • Glioma / pathology*
  • Glioma / surgery
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology
  • Humans
  • Intracranial Hypertension / epidemiology
  • Intracranial Hypertension / etiology
  • Karnofsky Performance Status
  • Male
  • Middle Aged
  • Postoperative Care
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Prospective Studies
  • Robotic Surgical Procedures* / instrumentation
  • Robotic Surgical Procedures* / methods
  • Robotic Surgical Procedures* / statistics & numerical data
  • Stereotaxic Techniques* / adverse effects
  • Stereotaxic Techniques* / instrumentation
  • Supratentorial Neoplasms / diagnosis
  • Supratentorial Neoplasms / pathology*
  • Supratentorial Neoplasms / surgery
  • Treatment Outcome
  • Young Adult