{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:10:59Z","timestamp":1785391859401,"version":"3.55.0"},"reference-count":27,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Leksell stereotactic system-based aspiration biopsy is a common procedure in the neurosurgical treatment of deep-seated or multiple brain lesions. This study aimed to evaluate the benefit of frameless biopsy using VarioGuide compared to frame-based biopsy using the Leksell stereotactic system (LSS). We analyzed all brain biopsies using VarioGuide or LSS at our neurooncological Department of Neurosurgery in the University Hospital of Bonn between January 2018 and August 2020. We analyzed demographic data, duration of surgery, size of lesion, localization, and early complications. Uni-variable analyses were carried out on data from both groups. In total, 109 biopsies were compared (40 VarioGuide vs. 69 LSS). Patients with VarioGuide were significant older (74 (62\u201380) years vs. 67 (57\u201376) years; p = 0.03) and had a shorter duration of general anesthesia (163 (138\u2013194) min vs. 193 (167\u2013215) min, p &lt; 0.001). We found no significant differences in surgery duration (VarioGuide median 28 min (IQR 20\u201338); LSS: median 30 min (IQR 25\u201339); p = 0.1352) or in early complication rates (5% vs. 7%; p = 0.644). A slightly higher false negative biopsy rate was registered in the LSS group (3 vs. 1; p = 0.1347). The size of the lesions also did not differ significantly between the two groups (18.31 \u00b1 26.35 cm3 vs. 12.63 \u00b1 14.62; p = 0.15). Our data showed that biopsies performed using VarioGuide took significantly less time than LSS biopsies and did not differ in complication rates. Both systems offered a high degree of patient safety.<\/jats:p>","DOI":"10.3390\/brainsci12091178","type":"journal-article","created":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T21:27:17Z","timestamp":1662067637000},"page":"1178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Patient Safety Comparison of Frameless and Frame-Based Stereotactic Navigation for Brain Biopsy\u2014A Single Center Cohort Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Martin","family":"Vychopen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4680-0412","authenticated-orcid":false,"given":"Johannes","family":"Wach","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5905-4121","authenticated-orcid":false,"given":"Valeri","family":"Borger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6025-7479","authenticated-orcid":false,"given":"Matthias","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9769-0639","authenticated-orcid":false,"given":"Lars","family":"Eichhorn","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3565-543X","authenticated-orcid":false,"given":"Jaroslaw","family":"Maciaczyk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Bara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Vatter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-5215","authenticated-orcid":false,"given":"Mohammed","family":"Banat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4828-7496","authenticated-orcid":false,"given":"Motaz","family":"Hamed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.3171\/2009.7.FOCUS09118","article-title":"Early history of the stereotactic apparatus in neurosurgery","volume":"27","author":"Rahman","year":"2009","journal-title":"Neurosurg. Focus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1159\/000099445","article-title":"Lars Leksell. Notes at the side of a raconteur","volume":"67","author":"Lunsford","year":"1996","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"107137","DOI":"10.1016\/j.clineuro.2022.107137","article-title":"Electrode placement for SEEG: Combining stereotactic technique with latest generation planning software for intraoperative visualization and postoperative evaluation of accuracy and accuracy predictors","volume":"213","author":"Kogias","year":"2022","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.clineuro.2018.01.015","article-title":"The stereotactic suboccipitaltranscerebellar approach to lesions of the brainstem and the cerebellum","volume":"166","author":"Nakagawa","year":"2018","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_5","first-page":"1042","article-title":"Clinical evaluation of frameless stereotaxy in minimally invasive neurosurgery","volume":"81","author":"Zhao","year":"2001","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1055\/s-2008-1053478","article-title":"Frameless neuronavigation in modern neurosurgery","volume":"38","author":"Spetzger","year":"1995","journal-title":"Min-Minim. Invasive Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s00701-007-1473-x","article-title":"Safety and efficacy of frameless and frame-based intracranial biopsy techniques","volume":"150","author":"Dammers","year":"2008","journal-title":"Acta Neurochir."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.ijom.2006.09.015","article-title":"Image-to-patient registration techniques in head surgery","volume":"35","author":"Eggers","year":"2006","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1227\/01.NEU.0000341532.15867.1C","article-title":"VarioGuide: A new frameless image-guided stereotactic system\u2013accuracy study and clinical assessment","volume":"64","author":"Ringel","year":"2009","journal-title":"Oper. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1108\/IJHCQA-02-2020-0025","article-title":"Association of patient safety indicator 03 and clinical outcome in a surgery hospital","volume":"33","author":"Hikal","year":"2020","journal-title":"Int. J. Health Care Qual. Assur."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.amjsurg.2019.11.019","article-title":"Postoperative respiratory failure: An update on the validity of the Agency for Healthcare Research and Quality Patient Safety Indicator 11 in an era of clinical documentation improvement programs","volume":"220","author":"Stocking","year":"2020","journal-title":"Am. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jocn.2020.04.067","article-title":"Hospital-acquired conditions occur more frequently in elective spine surgery than for other common elective surgical procedures","volume":"76","author":"Horn","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1159\/000504945","article-title":"Utilization of the Intraoperative Mobile AIRO\u00ae CT Scanner in Stereotactic Surgery: Workflow and Effectiveness","volume":"97","author":"Faust","year":"2019","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1097\/ALN.0b013e3181fc6e0a","article-title":"Prediction of postoperative pulmonary complications in a population-based surgical cohort","volume":"113","author":"Canet","year":"2010","journal-title":"J. Am. Soc. Anesthesiol."},{"key":"ref_15","first-page":"7053839","article-title":"Risk Factors for Postoperative Complications among the Elderly after Plastic Surgery Procedures Performed under General Anesthesia","volume":"2018","author":"Fukui","year":"2018","journal-title":"Plast. Surg. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3171\/jns.2006.104.2.233","article-title":"Frameless image-guided stereotactic brain biopsy procedure: Diagnostic yield, surgical morbidity, and comparison with the frame-based technique","volume":"104","author":"Woodworth","year":"2006","journal-title":"J. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Furtak, J., \u015aledzi\u0144ska, P., Bebyn, M.G., Szylberg, T., Krajewski, S., Birski, M., and Harat, M. (2021). Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions. Brain Sci., 11.","DOI":"10.3390\/brainsci11111432"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/(SICI)1098-2388(199801\/02)14:1<13::AID-SSU3>3.0.CO;2-5","article-title":"Role of stereotactic biopsy in the diagnosis and management of brain tumors","volume":"Volume 14","author":"Krieger","year":"1998","journal-title":"Seminars in Surgical Oncology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s10143-019-01234-w","article-title":"Complications after frame-based stereotactic brain biopsy: A systematic review","volume":"44","author":"Riche","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3171\/jns.1994.81.2.0165","article-title":"Complications of CT-guided stereotactic biopsy of intra-axial brain lesions","volume":"81","author":"Bernstein","year":"1994","journal-title":"J. Neurosurg."},{"key":"ref_21","first-page":"E148","article-title":"Morbidity of stereotactic biopsy for intracranial lesions","volume":"56","author":"Nishihara","year":"2011","journal-title":"Kobe J. Med. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00701-005-0495-5","article-title":"Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies","volume":"147","author":"Grossman","year":"2005","journal-title":"Acta Neurochir."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.clineuro.2009.08.013","article-title":"Stereotactic brain biopsy: Single center retrospective analysis of complications","volume":"111","author":"Chen","year":"2009","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-2003-37150","article-title":"Neuronavigation oder Stereotaxie? Eine Standortbestimmung zur Wahl des Verfahrens [Frame-less and frame-based stereotaxy? How to choose the appropriate procedure]","volume":"64","author":"Raabe","year":"2003","journal-title":"Zentralblatt Neurochir."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.wneu.2017.04.104","article-title":"Accuracy of VarioGuide Frameless Stereotactic System Against Frame-Based Stereotaxy: Prospective, Randomized, Single-Center Study","volume":"104","author":"Bradac","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s00701-019-03873-w","article-title":"Frameless stereotactic biopsy for precision neurosurgery: Diagnostic value, safety, and accuracy","volume":"161","author":"Sciortino","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1055\/s-0028-1102941","article-title":"Die \u201cIndustrialisierung\u201d des Krankenhauswesens durch DRG-Fallpauschalen\u2013eine interdisziplin\u00e4re Analyse [The \u201cIndustrialisation\u201d of the hospital sector by DRG-based prospective payment systems\u2013an interdisciplinary analysis]","volume":"71","author":"Vera","year":"2009","journal-title":"Gesundheitswesen"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/9\/1178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:21:46Z","timestamp":1760142106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/9\/1178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,1]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["brainsci12091178"],"URL":"https:\/\/doi.org\/10.3390\/brainsci12091178","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,1]]}}}