Comparison of the Diagnostic Efficacy of Frameless Stereotactic Biopsy (Varioguide) with Other Methods Reported in the Literature: A Single-Center Experience

Objective: To evaluate the diagnostic yield, complication profile, and demographic and radiological factors associated with procedural success in intracranial biopsies performed using the VarioGuide frameless stereotactic system. Materials and Methods:We retrospectively reviewed 58 consecutive patients who underwent VarioGuide-assisted frameless stereotactic brain biopsy between August 2018 and December 2025.All procedures were performed under general anesthesia using coregistered preoperative high-resolution computed tomography and magnetic resonance imaging datasets.The associations of age, sex, lesion volume, and contrast-enhancement pattern with diagnostic success and postoperative complications were evaluated using exploratory univariable analyses.Results: The cohort included 42 male (72.4%) and 16 female (27.6%) patients, with a mean age of 49.8±18.7 years.The diagnostic yield was 94.8% (55/58).The median age was 51 years (range, 6-79 years) among patients with diagnostic biopsies and 28 years (range, 2-41 years) among those with non-diagnostic biopsies (exact Mann-Whitney U test, p=0.020).Lesion volume (p=0.843),sex (p=0.181), and contrast-enhancement pattern (p>0.999) were not significantly associated with diagnostic success.Postoperative findings occurred in 10 patients (17.2%), including asymptomatic microhemorrhage in six (10.3%), pneumocephalus in two (3.4%), and symptomatic hematomas requiring surgical decompression in two (3.4%).Neither age (p=0.133)nor lesion volume (p=0.951)differed significantly according to complication status.Conclusion: In this retrospective single-center series, VarioGuide-assisted frameless stereotactic biopsy provided a high diagnostic yield and a low rate of major procedurerelated morbidity.Younger age was associated with a non-diagnostic biopsy in an exploratory analysis; however, this finding should be interpreted cautiously because only three biopsies were non-diagnostic.