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 performing frameless stereotactic biopsies using an Autoguide Robotic Platform and to compare the outcomes with a 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 a Stealth Autoguide Robotic Platform. Materials and Methods: We retrospectively evaluated 30 patients who underwent a stereotactic intracranial biopsy between June 2018 and March 2024. The patients were divided into two groups: The robotic biopsy group (n = 15) underwent a frameless image-guided stereotactic intracranial biopsy with a Stealth Autoguide Robotic Platform and optical neuronavigation system (Stealth-Station S8, Medtronic, Minneapolis, MN, USA) using intraoperative sodium fluorescein. The frame-based (Integra, CRW, New Jersey, USA) stereotactic biopsy group (n = 15) underwent a stereotactic biopsy with the use of a stereotactic planning system (Atlas Integra Software, NJ, USA and Brainlab AG, Munich, Germany) without sodium fluorescein. Preoperative MRI and CT scans were performed in all the patients. Their external cranial anatomy was registered using either facial tracing or O-Arm (Medtronic Sofamor Danek, Inc., Memphis, TN, USA). Results: The robotic biopsy group demonstrated a diagnostic yield of 93.3% (14/15), while the frame-based group achieved 100% (15/15), with no significant difference (p = 0.609). The mean calculated tip error in the robotic biopsy group was 0.42 ± 0.19 mm (range: 0.1–0.7 mm) and the postoperative targeting accuracy in the frame-based biopsy group was 0.51 ± 0.23 mm (range: 0.2–0.9 mm), with no significant difference (p = 0.287). The robotic biopsy group demonstrated a significantly shorter mean surgical time (40.26 ± 6.13 vs. 52.47 ± 8.92 min, p = 0.002). Conclusions: Both frame-based and robotic-assisted stereotactic biopsy techniques achieve comparable diagnostic accuracy and targeting precision. However, a robotic biopsy significantly reduces the surgical time compared to a 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.