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 co-registered 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 procedure-related 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.