Comparative Analysis of Frameless Robotic Stereotactic Biopsy with Intraoperative Sodium Fluorescein Versus Frame-Based Stereotactic Technique

Background and Objectives: The authors aimed to describe their experience in frameless stereotactic biopsy by using Autoguide Robotic Platform and compare outcomes with frame-based stereotactic technique. We would like to emphasize the importance of this study as it is the first in the literature to use sodium fluorescein for confirmation in intracranial biopsies taken with the Stealth Autoguide Robotic Platform. Materials and Methods: We retrospectively evaluated 30 patients who underwent stereotactic intracranial biopsy between June 2018 and March 2024. Patients were divided into two groups: Robotic biopsy group (n=15) underwent frameless image-guided stereotactic intracranial biopsy with Stealth Autoguide Robotic Platform and optical neuronavigation system (Stealth-Station S8, Medtronic, Minneapolis, MN, USA) by using intraoperative sodium fluorescein. Frame-based (Integra, CRW, New Jersey, USA) stereotactic biopsy group (n=15) underwent stereotactic biopsy with the use of a stereotactic planning system (Atlas Integra Software, New Jersey, USA and Brainlab AG, Munich, Germany), without sodium fluorescein and preoperative MRI and CT scans were performed in all patients. The external cranial anatomy was registered using either facial tracing or O-Arm (Medtronic Sofamor Danek, Inc., Memphis, TN, USA). Results: Robotic biopsy group demonstrated diagnostic yield of 93.3% (14/15) while frame-based group achieved 100% (15/15), with no significant difference (p=0.609). Mean calculated tip error in robotic biopsy group was 0.42±0.19 mm (range: 0.1-0.7 mm) and postoperative targeting accuracy in frame-based biopsy group was 0.51±0.23 mm (range: 0.2-0.9 mm), with no significant difference (p=0.287). robotic biopsy group demonstrated significantly shorter mean surgical time (40.26±6.13 vs 52.47±8.92 minutes, p=0.002). Conclusions: Both frame-based and robotic-assisted stereotactic biopsy techniques achieve comparable diagnostic accuracy and targeting precision. However, robotic biopsy significantly reduces surgical time compared to frame-based technique. The use of intraoperative sodium fluorescein is a valuable adjunct method for confirming that biopsy specimens are obtained from the intended target site.