ArticleNeurosurgical review2026
Diagnostic performance and safety of stereotactic frame-based biopsy for sub centimeter intracranial lesions: A matched cohort analysis.
Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Stereotactic brain biopsy is a standard neurosurgical procedure for diagnosing intracranial lesions. Lesion size is often considered a limiting factor; however, the safety and diagnostic yield of biopsies in lesions < 10 mm remain poorly defined. This study evaluated the outcomes of frame-based stereotactic biopsies for lesions < 10 mm in size compared with larger lesions. We retrospectively analyzed all consecutive adult patients who underwent frame-based stereotactic biopsy for targeted lesions < 10 mm in maximum diameter between April 2009 and April 2024 at our institution. Each case was matched (1:3) with patients with lesions ≥ 10 mm based on age, lesion location, and contrast enhancement. The primary endpoint was diagnostic yield, and the secondary endpoints included complications graded using a validated severity scale. Continuous variables were compared using Student’s t-test or Wilcoxon’s rank-sum test. Of the 2,347 patients who underwent frame-based stereotactic biopsy during the inclusion period, 74 patients (3.2%) with lesions < 10 mm were compared with 222 controls. Among the 296 patients, the overall diagnostic yield was 95%. The diagnostic yields did not significantly differ between the small and large lesion groups (91.9% vs. 96.0%, p = 0.2). Non-tumoral pathology was the main factor associated with non-diagnostic results. Symptomatic complications occurred in 4.1% of patients, with no significant difference between the groups (1.4% vs. 4.9%; p = 0.3). No severe complications occurred in the < 10 mm group. The overall mortality rate was 1.3%, with no mortality in the small-lesion cohort. Frame-based stereotactic biopsy of lesions < 10 mm is safe and effective, with a diagnostic yield comparable to that of larger lesions and no excess risk of complications. These findings challenge long-standing assumptions discouraging the biopsy of small lesions and support its use when clinically indicated.
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