Comparison of Robotic and Frame-based Stereotactic Biopsy in the Diagnostics of Focal Brain Lesions

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Brożek, Sandra A. Pilawska, Ewelina Grzywna, Wojciech Pietraszko, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7804401/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose For a long time, stereotactic brain biopsies have been an essential tool for establishing a treatment strategy, especially in deep-seated and compound lesions. With frame-based biopsy being the standard method, novel frameless robotic solutions are gradually entering mainstream use - potentially increasing diagnostic accuracy and precision. We aimed to compare the safety and efficacy of robot-assisted (RA) and frame-based manually-guided (MG) stereotactic biopsy in the diagnostics of focal brain lesions. Methods We conducted a retrospective analysis of 182 patients who underwent brain biopsy in the course of diagnostic evaluation of focal intracranial lesions, with special attention to duration of the procedure, procedural complications, diagnostic yield of the obtained material and type of diagnosed pathology. RA biopsy was performed with ROSA ONE® Brain System and MG with a RM or ZD stereotactic frame. Results The 182 patients underwent a total of 191 brain biopsies, including 52 cases of RA and 139 cases of MG. The mean total procedural duration was significantly shorter in the RA group (102.92 ± 57.86 min vs. 147.33 ± 34.93 min; p < 0.001). There were no statistically significant differences in terms of nondiagnostic biopsy rate (11.76% vs. 12.31%; p = 0.920), trajectory error (3.92% vs. 3.85%; p = 0.981) and the overall complication rate (15.69% vs. 24.64%; p = 0.189). Conclusion RA stereotactic biopsy is a reasonable alternative to MG, ensuring a comparable safety profile and diagnostic yield of the samples but with remarkably shorter procedural time. brain biopsy robotics stereotaxy stereotactic frame focal intracranial lesions Introduction Brain biopsies play a substantial role in setting the foundation for treatment decisions in intracranial lesions. With surgical techniques ranging all the way from open surgery to endoscopy [ 1 ], frame-based manually-guided (MG) stereotactic biopsy remains the most widely adopted approach [ 2 ]. While it is generally considered a safe and effective method [ 3 , 4 ], its complications may carry serious risks. Procedural complications reported in the literature include haemorrhage, with asymptomatic bleeding occurring in up to 59.8% of the cases [ 5 ], brain edema, neurological impairment, seizures and infections [ 6 ]. These are most likely to occur in elderly patients, with repeat biopsy due to inconclusive initial diagnosis, lesions located in the brainstem, pineal region and deep brain structures, as well as those with toxoplasmosis [ 7 ]. The observed negative biopsy rates range from 0.8%, up to 11.1% in cases with no intra-operative smear [ 8 ]. Given that, new technologies and innovations are gradually being introduced, in an attempt to improve the diagnostic yield and reduce complication rates of stereotactic brain biopsy - that including the use of robotics [ 9 ]. The objective of this study was to compare the safety and efficacy of MG and robot-assisted (RA) stereotactic biopsy. Methods Patients and data The study group consisted of 182 consecutive patients undergoing a brain biopsy between January 2020 - December 2024. Data concerning demographics, location of the lesion, total procedural duration, accuracy, complications and histopathological findings were collected retrospectively. The anatomical location was determined based on preoperative magnetic resonance imaging (MRI) or computed tomography (CT) scan, or a fusion of both. Assignment to the nondiagnostic biopsy category was determined by inconclusive histopathological diagnosis. Trajectory error was defined as deviation between the pre-planned surgical target point and the corresponding intraoperative target. All complications were additionally categorized in accordance with a classification of neurosurgical complications proposed by Landriel Ibañez et al. [ 10 ], exclusive of distinction between transient and persistent complications due to incomplete follow-up data. Postoperative hematoma not requiring a surgical intervention was not regarded as a complication. The exclusion criterion was a biopsy technique other than MG or RA. Biopsy technique For the RA, all patients underwent a CT scan and optionally, an MRI prior to surgery. All cases were performed with the assistance of the ROSA ONE® Brain System. Under general anaesthesia, in the supine position, the patient’s head was positioned with a Mayfield skull clamp and attached to the robot. Patient registration and trajectory planning was performed in the ROSA robotic software. The incision followed by a burr-hole was made in accordance with the planned trajectory and entry point. The biopsy needle was inserted and tissue samples obtained. All of the attained material was forwarded for histopathological analysis. Layered wound closure and placement of a sterile dressing completed the procedure. For the MG, RM or ZD stereotactic frames were used. Under general anaesthesia, in the supine position, the patient’s head was positioned with the stereotactic frame attached to the operating table. The patient was then transferred to the radiology unit for obtaining a head CT scan in the stereotactic protocol. Trajectory planning was performed in the Stealth Medtronic software, based on a CT scan or a fusion of both the CT and MRI acquired prior to admission. Back in the operating room, the incision and a burr-hole were made in accordance with the planned trajectory and entry point. The biopsy needle was inserted and tissue samples obtained. All of the attained material was forwarded for histopathological analysis. Layered wound closure and placement of a sterile dressing completed the procedure. On day 1 post surgery all patients underwent a control CT scan to ensure no excess bleeding or edema occurred. Statistical analysis The statistical analysis was performed with Statistica version 14.1.0.4 (Cloud Software Group, Inc., USA). We used the χ 2 test for proportional variables and Mann-Whitney test or t-test for continuous variables. The p-value of < 0.05 was considered significant. Continuous variables were presented as mean value ± standard deviation. Results Study group overview The 182 patients underwent a total of 191 brain biopsies. Females comprised 49.21% of the study group and the mean age was 60.26 ± 14.22. The ROSA ONE® Brain System was used in 52 (27.23%) cases, while the remaining 139 (72.77%) procedures were MG biopsies - that including 43 (30.94%) MGs with biopsy trajectory planned exclusively on the basis of preoperative CT scan and 79 (56.84%) based on the fusion of CT and MRI (Table 1 ). Table 1 Study group overview Variable Value Cases, n 191 Age, years ± SD 60.26 ± 14.22 Female, n (%) 94 (49.21) MG biopsy, n (%) 139 (72.77) CT-based, n (%) 43 (30.94) Fusion-based, n (%) 79 (56.84) RA biopsy, n (%) 52 (27.23) SD standard deviation, MG frame-based manually guided biopsy, RA robot-assisted biopsy Lesion characteristics The frontal area was the most prevalent location among studied lesions, in both the RA (53.85%) and MG group (42.25%). Involvement of deep cerebral structures was observed in 42.31% and 49.64% of the cases. Overall, 7.85% of the lesions extended into the ventricular system. There were more lesions with corpus callosum involvement within the RA group (36.54% vs. 21.58; p = 0.035). The mean preoperative midline shift reached 2.15 ± 3.45 mm. The most commonly diagnosed pathologies were glioblastoma (34.00% and 38.28%) and lymphoma (18.00% and 21.88%) (Table 2 ). Table 2 Lesion characteristics Variable Total (N = 191) MG biopsy (N = 139) RA biopsy (N = 52) p-value Lesion laterality Right, n (%) 55 (28.80) 39 (28.06) 16 (30.77) 0.713 Left, n (%) 74 (38.74) 58 (41.73) 16 (30.77) 0.167 Right + left, n (%) 49 (25.65) 33 (23.74) 16 (30.77) 0.322 Midline, n (%) 71 (37.17) 49 (35.25) 22 (42.31) 0.369 Lesion location Frontal area, n (%) 87 (45.55) 59 (42.45) 28 (53.85) 0.159 Parietal area, n (%) 55 (28.80) 42 (30.22) 13 (25.00) 0.479 Temporal area, n (%) 47 (24.61) 32 (23.02) 15 (28.85) 0.406 Occipital area, n (%) 20 (10.47) 15 (10.79) 5 (9.62) 0.813 Corpus callosum, n (%) 49 (25.65) 20 (21.58) 19 (36.54) 0.035 * Insula, n (%) 10 (5.24) 7 (5.04) 3 (5.77) 0.841 Cingulate gyrus, n (%) 2 (1.05) 1 (0.72) 1 (1.92) 0.493 Basal ganglia / deep structures, n (%) 91 (47.64) 69 (49.64) 22 (42.31) 0.366 Thalamus, n (%) 31 (16.23) 26 (18.71) 5 (9.62) 0.129 Pineal gland, n (%) 2 (1.05) 1 (0.72) 1 (1.92) 0.493 Pituitary gland, n (%) 3 (1.57) 2 (1.44) 1 (1.92) 0.815 Brainstem, n (%) 17 (8.90) 11 (7.91) 6 (11.54) 0.434 Cerebellum, n (%) 3 (1.57) 2 (1.44) 1 (1.92) 0.815 Cerebellopontine angle, n (%) 1 (0.52) 0 (0.00) 1 (1.92) 0.106 Lateral ventricle, n (%) 11 (5.76) 10 (7.19) 1 (1.92) 0.124 Third ventricle, n (%) 4 (2.09) 4 (2.88) 0 (0.00) 0.109 Intracranial nerves, n (%) 4 (2.09) 4 (2.88) 0 (0.00) 0.109 Midline shift, mm ± SD 2.15 ± 3.45 2.07 ± 3.51 2.34 ± 3.32 0.653 Diagnosis Glioblastoma, n (%) 66 (37.08) 49 (38.28) 17 (34.00) 0.595 Astrocytoma, n (%) 20 (11.24) 15 (11.72) 5 (10.00) 0.744 Oligodendroglioma, n (%) 10 (5.62) 4 (3.13) 6 (12.00) 0.030 * Plexus papilloma, n (%) 1 (0.56) 1 (0.78) 0 (0.00) 0.416 Rosette-forming glioneuronal tumor, n (%) 1 (0.56) 0 (0.00) 1 (2.00) 0.110 Ganglioglioma, n (%) 1 (0.56) 1 (0.78) 0 (0.00) 0.416 Subependymoma, n (%) 1 (0.56) 1 (0.78) 0 (0.00) 0.416 Lymphoma, n (%) 37 (20.79) 28 (21.88) 9 (18.00) 0.567 Germinoma, n (%) 1 (0.56) 1 (0.78) 0 (0.00) 0.416 Other metastases, n (%) 6 (3.37) 4 (3.13) 2 (4.00) 0.775 Non-neoplastic pathology, n (%) 11 (6.08) 8 (6.15) 3 (5.88) 0.945 Nondiagnostic biopsy, n (%) 22 (12.15) 16 (12.31) 6 (11.76) 0.920 Trajectory error, n (%) 7 (3.87) 5 (3.85) 2 (3.92) 0.981 SD standard deviation, MG frame-based manually guided biopsy, RA robot-assisted biopsy * p-values of < 0.05 are considered significant Procedural time and diagnostic yield The mean total procedural duration was significantly shorter in the RA group (102.92 ± 57.86 min vs. 147.33 ± 34.93 min; p < 0.001) (Table 3 ). However, it is important to note that, as said in the description of biopsy technique, in MG total procedural time also includes transferring the patient for a CT scan of the head. No statistically significant differences in terms of nondiagnostic biopsy rate (11.76% vs. 12.31%; p = 0.920) and trajectory error (3.92% vs. 3.85%; p = 0.981) were found between the two groups (Table 2 ). Table 3 Surgery characteristics and outcomes Variable Total (N = 191) MG biopsy (N = 139) RA biopsy (N = 52) p-value Total procedural duration, mins ± SD 134.13 ± 47.44 147.33 ± 34.93 102.92 ± 57.86 < 0.001 * Postoperative complications Overall complication rate, n (%) 42 (22.22) 34 (24.64) 8 (15.69) 0.189 Psychomotor retardation, n (%) 7 (3.70) 5 (3.62) 2 (3.92) 0.924 Orientation impairment, n (%) 6 (3.17) 5 (3.62) 1 (1.96) 0.544 Consciousness impairment, n (%) 2 (1.06) 1 (0.72) 1 (1.96) 0.488 Memory impairment, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Balance impairment, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Motor coordination impairment, n (%) 2 (1.06) 1 (0.72) 1 (1.96) 0.488 Sensory impairment, n (%) 2 (1.06) 2 (1.45) 0 (0.00) 0.261 Speech impairment, n (%) 14 (7.41) 12 (8.70) 2 (3.92) 0.238 Visual impairment, n (%) 2 (1.06) 2 (1.45) 0 (0.00) 0.261 Headache, n (%) 4 (2.12) 4 (2.90) 0 (0.00) 0.111 Vertigo, n (%) 3 (1.59) 2 (1.45) 1 (1.96) 0.807 Limb paresis, n (%) 25 (13.23) 19 (13.77) 6 (11.76) 0.718 Limb paralysis, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Facial nerve paresis, n (%) 2 (1.06) 2 (1.45) 0 (0.00) 0.261 Exotropia, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Nausea / vomiting, n (%) 4 (2.12) 3 (2.17) 1 (1.96) 0.927 Transient cerebrospinal fluid leak from the wound, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Subfalcine and uncal herniation, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Death, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Hydrocephalus, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Lower-limb thrombosis, n (%) 1 (0.53) 0 (0.00) 1 (1.96) 0.105 Landriel Ibañez classification Grade I, n (%) 38 (20.11) 31 (22.46) 7 (13.73) 0.183 Ia, n (%) 14 (7.41) 13 (9.42) 1 (1.96) 0.051 * Ib, n (%) 24 (12.70) 18 (13.04) 6 (11.76) 0.815 Grade II, n (%) 3 (1.59) 2 (1.45) 1 (1.96) 0.807 IIa, n (%) 1 (0.53) 0 (0.00) 1 (1.96) 0.105 IIb, n (%) 2 (1.06) 2 (1.45) 0 (0.00) 0.261 Grade IV, n (%) 1 (0.53) 1 (0.72) 0 (0.00) 0.427 Surgical complications, n (%) 40 (21.16) 33 (23.91) 7 (13.73) 0.128 Medical complications, n (%) 2 (1.06) 1 (0.72) 1 (1.96) 0.488 SD standard deviation, MG frame-based manually guided biopsy, RA robot-assisted biopsy * p-values of < 0.05 are considered significant Clinical outcomes The differences between the overall complication rates within RA and MG groups did not reach statistical significance (15.69% vs. 24.64%; p = 0.189). Limb paresis (11.76% and 13.77%) and speech impairment (3.93% and 8.70%) were the most frequently reported postprocedural complications. Transient leak of cerebrospinal fluid at the wound site, as well as complications resulting in death occurred in one MG case each. As per the Landriel Ibañez classification of complications in neurosurgery, the most prevalent in both RA and MG groups were Grade I complications (13.73% and 22.46%) - any deviations from normal postoperative course, which may require pharmacotherapy, but no invasive treatment. Among these, a trend towards more frequent Grade Ia complications (not requiring pharmacotherapy) was observed within the MG group (1.96% vs. 9.42%; p = 0.051). There were two cases of medical complications, not directly connected to the surgery itself (Table 3 ). Discussion In this study, we aimed to compare the safety and efficacy of RA and MG in the course of diagnostic evaluation of focal brain lesions. Our key findings were: (1) RA is a significantly shorter procedure in comparison to MG; (2) There are no relevant differences between RA and MG in terms of diagnostic yield of the obtained material, trajectory accuracy and procedural complication rates. The one case of a Grade IIa complication (requiring intervention without the use of general anaesthesia) was lower-limb deep vein thrombosis on the third postoperative day, followed by placement of an inferior vena cava filter. The procedural complications categorized as Grade IIb (requiring intervention under general anaesthesia) were subfalcine and uncal herniation due to extensive cerebral oedema, with subsequent emergency reoperation - decompressive craniotomy and tumor resection and hydrocephalus requiring ventriculo-peritoneal shunt placement on the second day post biopsy. The one Grade IV patient suffered an intraoperatively induced intracranial haemorrhage followed by prolonged hospitalization in the intensive care unit and eventual death. Our findings align with those reported in the literature. In a recent meta-analysis comprising 2665 RA and 9801 MG patients, Gecici NN et al. showed significantly shorter total operative duration of RA in comparison with MG (76.6 min vs. 132.7 min; p < 0.001) along with similar pooled rates of postoperative neurological deficit and haemorrhage, but significantly higher pooled diagnostic yield rates of RA (97% vs. 95%; p < 0.001) [ 11 ]. While most researchers agree that performing RA instead of MG results in considerably reduced overall surgery time, with RA being 10-39.8 minutes shorter than MG [ 12 – 15 ], findings regarding the diagnostic yield of both procedures are varied. A review conducted by Gomes FC et al. demonstrated higher diagnostic yield of RA (OR: 2.06; 95% CI: 1.01–4.21; p = 0.04) [ 16 ], similarly to Spyrantis A et al. (98% vs. 91%; p = 0.0036) [ 14 ], whereas comparative studies on MG and Remebot RA or SINO RA did not reflect a similar trend [ 12 , 13 , 15 ]. Neither approach demonstrated superiority with respect to incidence of postoperative complications [ 12 – 15 ]. The impact of RA and MG on trajectory accuracy, entry point error and target point error remains controversial as well [ 13 , 16 ]. Studies have also identified lower mortality rate of RA (0% vs. 0.001%; p < 0.001) [ 11 ] and higher overall discomfort of MG patients quantified via the visual analogue scale (1.5 ± 0.7 vs. 2.7 ± 1.2; p = 0.001) [ 15 ]. The main limitations of our study are its retrospective nature and a relatively small patient group. Besides that, MGs were performed with two different types of stereotactic frames. Imaging methods used in trajectory planning also varied between cases - either CT-based or MRI and CT fusion-based planning was employed. A standardized approach to these two factors could potentially affect the results. Conclusion RA poses a non-inferior alternative to MG with its shorter total procedural duration and comparable efficacy and safety profile, however combined with the financial factors, it might not necessarily be considered favourable. Declarations Founding Studie received no funding Human Ethics and Consent to Participate declarations Approved by Jagiellonian University Bioethical Committee Number 1072/6120/84/2024). All participant gave informed consent. The study was performed in accordance with the Declaration of Helsinki Clinical trial number not applicable Author Contribution Gabriela A. Brożek- data collection, manuscript preparationSandra A. Pilawska- data collection, manuscript preparationEwelina Grzywna- softwareWojciech Pietraszko- data analysisKrzysztof Stachura- study suppervision, data curractionBorys M. Kwinta- study suppervision, data curractionRoger M. Krzyżewski- study suppervision, manuscript corretio References Giannetti AV, Alvarenga AY, de Lima TO, Pedrosa HA, Souweidane MM (2015) Neuroendoscopic biopsy of brain lesions: accuracy and complications. J Neurosurg 122(1):34–39. https://doi.org/10.3171/2014.9.JNS132648 Mathon B, Amelot A, Mokhtari K, Bielle F (2019) Increasing the diagnostic yield of stereotactic brain biopsy using intraoperative histological smear. Clin Neurol Neurosurg 186:105544. https://doi.org/10.1016/j.clineuro.2019.105544 Kesserwan MA, Shakil H, Lannon M, McGinn R, Banfield L, Nath S, Alotaibi M, Kasper E, Sharma S (2021) Frame-based versus frameless stereotactic brain biopsies: A systematic review and meta-analysis. 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Neurosurg Rev 47(1):880. https://doi.org/10.1007/s10143-024-03121-5 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7804401","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":536160324,"identity":"020bcdcd-c9b0-4994-b90c-82feaa921914","order_by":0,"name":"Gabriela A. Brożek","email":"","orcid":"","institution":"Jagiellonian University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Gabriela","middleName":"A.","lastName":"Brożek","suffix":""},{"id":536160325,"identity":"1b0d8cf5-7510-44cb-94f8-06254a572e17","order_by":1,"name":"Sandra A. 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05:53:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7804401/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7804401/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94735849,"identity":"1d2240e0-90c8-47f6-8295-b262294848c1","added_by":"auto","created_at":"2025-10-30 07:43:54","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7538,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7804401/v1/98198e4211bc62b49379d63c.docx"},{"id":94735850,"identity":"a761f228-b136-4238-90e9-17c4d89ab382","added_by":"auto","created_at":"2025-10-30 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07:43:54","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":89714,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7804401/v1/4d96dcc9afb0476b30ef71e7.html"},{"id":94827243,"identity":"4f7e726c-5f3b-4274-90d5-51d7a950fd85","added_by":"auto","created_at":"2025-10-31 06:56:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":764222,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7804401/v1/6009c2c3-08b0-4f76-8037-1216dfd43200.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Robotic and Frame-based Stereotactic Biopsy in the Diagnostics of Focal Brain Lesions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBrain biopsies play a substantial role in setting the foundation for treatment decisions in intracranial lesions. With surgical techniques ranging all the way from open surgery to endoscopy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], frame-based manually-guided (MG) stereotactic biopsy remains the most widely adopted approach [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile it is generally considered a safe and effective method [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], its complications may carry serious risks. Procedural complications reported in the literature include haemorrhage, with asymptomatic bleeding occurring in up to 59.8% of the cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], brain edema, neurological impairment, seizures and infections [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These are most likely to occur in elderly patients, with repeat biopsy due to inconclusive initial diagnosis, lesions located in the brainstem, pineal region and deep brain structures, as well as those with toxoplasmosis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The observed negative biopsy rates range from 0.8%, up to 11.1% in cases with no intra-operative smear [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven that, new technologies and innovations are gradually being introduced, in an attempt to improve the diagnostic yield and reduce complication rates of stereotactic brain biopsy - that including the use of robotics [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe objective of this study was to compare the safety and efficacy of MG and robot-assisted (RA) stereotactic biopsy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients and data\u003c/h2\u003e\u003cp\u003eThe study group consisted of 182 consecutive patients undergoing a brain biopsy between January 2020 - December 2024. Data concerning demographics, location of the lesion, total procedural duration, accuracy, complications and histopathological findings were collected retrospectively. The anatomical location was determined based on preoperative magnetic resonance imaging (MRI) or computed tomography (CT) scan, or a fusion of both. Assignment to the nondiagnostic biopsy category was determined by inconclusive histopathological diagnosis. Trajectory error was defined as deviation between the pre-planned surgical target point and the corresponding intraoperative target. All complications were additionally categorized in accordance with a classification of neurosurgical complications proposed by Landriel Iba\u0026ntilde;ez et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], exclusive of distinction between transient and persistent complications due to incomplete follow-up data. Postoperative hematoma not requiring a surgical intervention was not regarded as a complication. The exclusion criterion was a biopsy technique other than MG or RA.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBiopsy technique\u003c/h3\u003e\n\u003cp\u003eFor the RA, all patients underwent a CT scan and optionally, an MRI prior to surgery. All cases were performed with the assistance of the ROSA ONE\u0026reg; Brain System. Under general anaesthesia, in the supine position, the patient\u0026rsquo;s head was positioned with a Mayfield skull clamp and attached to the robot. Patient registration and trajectory planning was performed in the ROSA robotic software. The incision followed by a burr-hole was made in accordance with the planned trajectory and entry point. The biopsy needle was inserted and tissue samples obtained. All of the attained material was forwarded for histopathological analysis. Layered wound closure and placement of a sterile dressing completed the procedure.\u003c/p\u003e\u003cp\u003eFor the MG, RM or ZD stereotactic frames were used. Under general anaesthesia, in the supine position, the patient\u0026rsquo;s head was positioned with the stereotactic frame attached to the operating table. The patient was then transferred to the radiology unit for obtaining a head CT scan in the stereotactic protocol. Trajectory planning was performed in the Stealth Medtronic software, based on a CT scan or a fusion of both the CT and MRI acquired prior to admission. Back in the operating room, the incision and a burr-hole were made in accordance with the planned trajectory and entry point. The biopsy needle was inserted and tissue samples obtained. All of the attained material was forwarded for histopathological analysis. Layered wound closure and placement of a sterile dressing completed the procedure. On day 1 post surgery all patients underwent a control CT scan to ensure no excess bleeding or edema occurred.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe statistical analysis was performed with Statistica version 14.1.0.4 (Cloud Software Group, Inc., USA). We used the χ\u003csup\u003e2\u003c/sup\u003e test for proportional variables and Mann-Whitney test or t-test for continuous variables. The p-value of \u0026lt;\u0026thinsp;0.05 was considered significant. Continuous variables were presented as mean value\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStudy group overview\u003c/h2\u003e\u003cp\u003eThe 182 patients underwent a total of 191 brain biopsies. Females comprised 49.21% of the study group and the mean age was 60.26\u0026thinsp;\u0026plusmn;\u0026thinsp;14.22. The ROSA ONE\u0026reg; Brain System was used in 52 (27.23%) cases, while the remaining 139 (72.77%) procedures were MG biopsies - that including 43 (30.94%) MGs with biopsy trajectory planned exclusively on the basis of preoperative CT scan and 79 (56.84%) based on the fusion of CT and MRI (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudy group overview\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCases, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.26\u0026thinsp;\u0026plusmn;\u0026thinsp;14.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (49.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMG biopsy, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e139 (72.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT-based, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (30.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFusion-based, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (56.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRA biopsy, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (27.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003eSD\u003c/em\u003e standard deviation, \u003cem\u003eMG\u003c/em\u003e frame-based manually guided biopsy, \u003cem\u003eRA\u003c/em\u003e robot-assisted biopsy\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLesion characteristics\u003c/h2\u003e\u003cp\u003eThe frontal area was the most prevalent location among studied lesions, in both the RA (53.85%) and MG group (42.25%). Involvement of deep cerebral structures was observed in 42.31% and 49.64% of the cases. Overall, 7.85% of the lesions extended into the ventricular system. There were more lesions with corpus callosum involvement within the RA group (36.54% vs. 21.58; p\u0026thinsp;=\u0026thinsp;0.035). The mean preoperative midline shift reached 2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45 mm. The most commonly diagnosed pathologies were glioblastoma (34.00% and 38.28%) and lymphoma (18.00% and 21.88%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLesion characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;191)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMG biopsy (N\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRA biopsy (N\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eLesion laterality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (28.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (28.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (30.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.713\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (38.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (41.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (30.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u0026thinsp;+\u0026thinsp;left, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (25.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (23.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (30.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.322\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidline, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (37.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (35.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (42.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eLesion location\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrontal area, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (45.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (42.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (53.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.159\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParietal area, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (28.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (30.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (25.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTemporal area, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (24.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (23.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (28.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.406\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccipital area, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (10.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (10.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (9.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorpus callosum, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (25.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (21.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (36.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.035\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsula, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (5.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (5.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (5.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.841\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCingulate gyrus, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.493\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasal ganglia / deep structures, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91 (47.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (49.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (42.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.366\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThalamus, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (16.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (18.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (9.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePineal gland, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.493\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePituitary gland, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.815\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrainstem, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (8.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (7.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (11.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.434\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebellum, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.815\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebellopontine angle, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLateral ventricle, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (5.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (7.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.124\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird ventricle, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracranial nerves, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidline shift, mm\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.653\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eDiagnosis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlioblastoma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (37.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (38.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (34.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAstrocytoma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (11.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (11.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.744\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOligodendroglioma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (5.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (12.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.030\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlexus papilloma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRosette-forming glioneuronal tumor, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGanglioglioma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubependymoma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphoma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (20.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (21.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (18.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.567\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGerminoma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther metastases, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-neoplastic pathology, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (6.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (6.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (5.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.945\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNondiagnostic biopsy, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (12.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (12.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (11.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.920\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrajectory error, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.981\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eSD\u003c/em\u003e standard deviation, \u003cem\u003eMG\u003c/em\u003e frame-based manually guided biopsy, \u003cem\u003eRA\u003c/em\u003e robot-assisted biopsy\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003ep-values of \u0026lt;\u0026thinsp;0.05 are considered significant\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProcedural time and diagnostic yield\u003c/h3\u003e\n\u003cp\u003eThe mean total procedural duration was significantly shorter in the RA group (102.92\u0026thinsp;\u0026plusmn;\u0026thinsp;57.86 min vs. 147.33\u0026thinsp;\u0026plusmn;\u0026thinsp;34.93 min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, it is important to note that, as said in the description of biopsy technique, in MG total procedural time also includes transferring the patient for a CT scan of the head. No statistically significant differences in terms of nondiagnostic biopsy rate (11.76% vs. 12.31%; p\u0026thinsp;=\u0026thinsp;0.920) and trajectory error (3.92% vs. 3.85%; p\u0026thinsp;=\u0026thinsp;0.981) were found between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSurgery characteristics and outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;191)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMG biopsy (N\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRA biopsy (N\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal procedural duration, mins\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e134.13\u0026thinsp;\u0026plusmn;\u0026thinsp;47.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e147.33\u0026thinsp;\u0026plusmn;\u0026thinsp;34.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102.92\u0026thinsp;\u0026plusmn;\u0026thinsp;57.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ePostoperative complications\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall complication rate, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (24.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (15.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychomotor retardation, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.924\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrientation impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsciousness impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.488\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMemory impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBalance impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotor coordination impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.488\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSensory impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.261\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpeech impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (7.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (8.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual impairment, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.261\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeadache, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVertigo, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimb paresis, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (13.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (13.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (11.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.718\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimb paralysis, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacial nerve paresis, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.261\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExotropia, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNausea / vomiting, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.927\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransient cerebrospinal fluid leak from the wound, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubfalcine and uncal herniation, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHydrocephalus, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower-limb thrombosis, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eLandriel Iba\u0026ntilde;ez classification\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade I, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (20.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (22.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (13.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIa, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (7.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (9.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.051\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIb, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (12.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (13.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (11.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.815\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade II, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIa, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIb, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.261\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade IV, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical complications, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (21.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (23.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (13.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical complications, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.488\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eSD\u003c/em\u003e standard deviation, \u003cem\u003eMG\u003c/em\u003e frame-based manually guided biopsy, \u003cem\u003eRA\u003c/em\u003e robot-assisted biopsy\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003ep-values of \u0026lt;\u0026thinsp;0.05 are considered significant\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eClinical outcomes\u003c/h3\u003e\n\u003cp\u003eThe differences between the overall complication rates within RA and MG groups did not reach statistical significance (15.69% vs. 24.64%; p\u0026thinsp;=\u0026thinsp;0.189). Limb paresis (11.76% and 13.77%) and speech impairment (3.93% and 8.70%) were the most frequently reported postprocedural complications. Transient leak of cerebrospinal fluid at the wound site, as well as complications resulting in death occurred in one MG case each.\u003c/p\u003e\u003cp\u003eAs per the Landriel Iba\u0026ntilde;ez classification of complications in neurosurgery, the most prevalent in both RA and MG groups were Grade I complications (13.73% and 22.46%) - any deviations from normal postoperative course, which may require pharmacotherapy, but no invasive treatment. Among these, a trend towards more frequent Grade Ia complications (not requiring pharmacotherapy) was observed within the MG group (1.96% vs. 9.42%; p\u0026thinsp;=\u0026thinsp;0.051). There were two cases of medical complications, not directly connected to the surgery itself (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we aimed to compare the safety and efficacy of RA and MG in the course of diagnostic evaluation of focal brain lesions. Our key findings were: (1) RA is a significantly shorter procedure in comparison to MG; (2) There are no relevant differences between RA and MG in terms of diagnostic yield of the obtained material, trajectory accuracy and procedural complication rates.\u003c/p\u003e\u003cp\u003eThe one case of a Grade IIa complication (requiring intervention without the use of general anaesthesia) was lower-limb deep vein thrombosis on the third postoperative day, followed by placement of an inferior vena cava filter. The procedural complications categorized as Grade IIb (requiring intervention under general anaesthesia) were subfalcine and uncal herniation due to extensive cerebral oedema, with subsequent emergency reoperation - decompressive craniotomy and tumor resection and hydrocephalus requiring ventriculo-peritoneal shunt placement on the second day post biopsy. The one Grade IV patient suffered an intraoperatively induced intracranial haemorrhage followed by prolonged hospitalization in the intensive care unit and eventual death.\u003c/p\u003e\u003cp\u003eOur findings align with those reported in the literature. In a recent meta-analysis comprising 2665 RA and 9801 MG patients, Gecici NN et al. showed significantly shorter total operative duration of RA in comparison with MG (76.6 min vs. 132.7 min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) along with similar pooled rates of postoperative neurological deficit and haemorrhage, but significantly higher pooled diagnostic yield rates of RA (97% vs. 95%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While most researchers agree that performing RA instead of MG results in considerably reduced overall surgery time, with RA being 10-39.8 minutes shorter than MG [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], findings regarding the diagnostic yield of both procedures are varied. A review conducted by Gomes FC et al. demonstrated higher diagnostic yield of RA (OR: 2.06; 95% CI: 1.01\u0026ndash;4.21; p\u0026thinsp;=\u0026thinsp;0.04) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], similarly to Spyrantis A et al. (98% vs. 91%; p\u0026thinsp;=\u0026thinsp;0.0036) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], whereas comparative studies on MG and Remebot RA or SINO RA did not reflect a similar trend [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Neither approach demonstrated superiority with respect to incidence of postoperative complications [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The impact of RA and MG on trajectory accuracy, entry point error and target point error remains controversial as well [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies have also identified lower mortality rate of RA (0% vs. 0.001%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and higher overall discomfort of MG patients quantified via the visual analogue scale (1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 vs. 2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2; p\u0026thinsp;=\u0026thinsp;0.001) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe main limitations of our study are its retrospective nature and a relatively small patient group. Besides that, MGs were performed with two different types of stereotactic frames. Imaging methods used in trajectory planning also varied between cases - either CT-based or MRI and CT fusion-based planning was employed. A standardized approach to these two factors could potentially affect the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRA poses a non-inferior alternative to MG with its shorter total procedural duration and comparable efficacy and safety profile, however combined with the financial factors, it might not necessarily be considered favourable.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eFounding\u003c/h2\u003e\u003cp\u003eStudie received no funding\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003cp\u003e Approved by Jagiellonian University Bioethical Committee Number 1072/6120/84/2024). All participant gave informed consent. The study was performed in accordance with the Declaration of Helsinki\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003cp\u003enot applicable\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eGabriela A. Brożek- data collection, manuscript preparationSandra A. Pilawska- data collection, manuscript preparationEwelina Grzywna- softwareWojciech Pietraszko- data analysisKrzysztof Stachura- study suppervision, data curractionBorys M. Kwinta- study suppervision, data curractionRoger M. Krzyżewski- study suppervision, manuscript corretio\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGiannetti AV, Alvarenga AY, de Lima TO, Pedrosa HA, Souweidane MM (2015) Neuroendoscopic biopsy of brain lesions: accuracy and complications. 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Neurosurg Rev 47(1):880. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10143-024-03121-5\u003c/span\u003e\u003cspan address=\"10.1007/s10143-024-03121-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"brain biopsy, robotics, stereotaxy, stereotactic frame, focal intracranial lesions","lastPublishedDoi":"10.21203/rs.3.rs-7804401/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7804401/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eFor a long time, stereotactic brain biopsies have been an essential tool for establishing a treatment strategy, especially in deep-seated and compound lesions. With frame-based biopsy being the standard method, novel frameless robotic solutions are gradually entering mainstream use - potentially increasing diagnostic accuracy and precision. We aimed to compare the safety and efficacy of robot-assisted (RA) and frame-based manually-guided (MG) stereotactic biopsy in the diagnostics of focal brain lesions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e We conducted a retrospective analysis of 182 patients who underwent brain biopsy in the course of diagnostic evaluation of focal intracranial lesions, with special attention to duration of the procedure, procedural complications, diagnostic yield of the obtained material and type of diagnosed pathology. RA biopsy was performed with ROSA ONE\u0026reg; Brain System and MG with a RM or ZD stereotactic frame.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe 182 patients underwent a total of 191 brain biopsies, including 52 cases of RA and 139 cases of MG. The mean total procedural duration was significantly shorter in the RA group (102.92\u0026thinsp;\u0026plusmn;\u0026thinsp;57.86 min vs. 147.33\u0026thinsp;\u0026plusmn;\u0026thinsp;34.93 min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no statistically significant differences in terms of nondiagnostic biopsy rate (11.76% vs. 12.31%; p\u0026thinsp;=\u0026thinsp;0.920), trajectory error (3.92% vs. 3.85%; p\u0026thinsp;=\u0026thinsp;0.981) and the overall complication rate (15.69% vs. 24.64%; p\u0026thinsp;=\u0026thinsp;0.189).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eRA stereotactic biopsy is a reasonable alternative to MG, ensuring a comparable safety profile and diagnostic yield of the samples but with remarkably shorter procedural time.\u003c/p\u003e","manuscriptTitle":"Comparison of Robotic and Frame-based Stereotactic Biopsy in the Diagnostics of Focal Brain Lesions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 07:43:50","doi":"10.21203/rs.3.rs-7804401/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cafdcd8c-6ef3-46e9-9cad-e41ba043d420","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T08:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 07:43:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7804401","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7804401","identity":"rs-7804401","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}