Operative Neurosurgery 28:749–761, 2025
This systematic review and meta-analysis compares frame-based, frameless, and robot-assisted stereotactic brain biopsies. Robot-assisted biopsies demonstrated non-inferior diagnostic yield and safety compared to traditional methods, with shorter operative times. Complication and mortality rates were similar across all techniques, supporting robot-assisted biopsy as an effective alternative.
• Frame-based stereotactic brain biopsy has been the gold standard for high diagnostic yield and safety, especially for complex or deep-seated lesions.
• Frameless neuronavigation and robot-assisted techniques have emerged as alternatives over the past decade.
• Meta-analysis included 92 studies: 9801 frame-based, 2665 robot-assisted, and 1862 frameless cases.
• Pooled diagnostic yields: robot-assisted 97%, frame-based 95%, frameless 94%; robot-assisted was not inferior.
• Complication and mortality rates were low and similar across all methods.
• Robot-assisted procedures had significantly shorter total operative times (mean 76.6 min) compared to frame-based (132.7 min) and frameless (97.3 min).
• Diagnostic yield for brainstem lesions was comparable between robot-assisted and frame-based approaches.
• Robot-assisted biopsy may offer workflow, comfort, and efficiency advantages, especially for certain patient groups.
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