Diagnostic yield, safety, and molecular-era clinical utility of stereotactic biopsy for brainstem lesions: a contemporary systematic review and meta-analysis
Abstract
Background/objectives Stereotactic biopsy of brainstem lesions must balance diagnostic and molecular information against procedure-related neurological risk. We updated the evidence base after a reviewer-directed literature coverage and overlap audit. Methods This PRISMA 2020 systematic review and meta-analysis was registered in PROSPERO (CRD420261432357). Searches covered English and Chinese bibliographic databases, trial registries, and Google Scholar, with forward and backward citation tracking during revision. Diagnostic yield and overall complications were analyzed with logit random-effects models; permanent neurological morbidity and procedure-related mortality were analyzed with binomial-normal generalized linear mixed models (GLMMs). Molecular clinical utility was synthesized narratively because its constructs and denominators were heterogeneous. Results Seventy-six reports met review-level eligibility (71 full-text and 5 abstract/conference reports), and 55 independent studies contributed to at least one preferred quantitative synthesis. Diagnostic yield was 1,814/1,956, with a pooled estimate of 93.5% (95% CI, 91.5%–95.0%). Overall complications were 162/1,797, with a pooled estimate of 10.5% (95% CI, 8.5%–12.8%). Permanent neurological morbidity was reported in 17 compatible studies (14/859; GLMM 0.83%, 95% CI, 0.22%–3.03%). Procedure-related mortality was 11/1,765 (crude 0.62%, exact 95% CI, 0.31%–1.11%); the primary GLMM estimate was 0.30% (95% CI, 0.07%–1.24%), whereas continuity-corrected models produced higher estimates. Diagnostic yield remained 93.7% (95% CI, 91.3%–95.5%) after excluding studies with fewer than 20 participants, although observed yield was inversely associated with study size. Conclusions In selected published cohorts, stereotactic biopsy provided high diagnostic yield. Overall complications were clinically meaningful, while observed procedure-related mortality was below 1% and permanent morbidity was uncommon but imprecisely estimated. Population, era, technique, outcome definition, and small-study analyses support cautious individualized interpretation rather than a universal biopsy recommendation. PROSPERO registration CRD420261432357