CT、MRI引导立体定向脑活检术的临床研究

目的评价CT或MRI引导立体定向活检术在确定脑深部病变的病理组织学诊断及选择适宜的治疗方法中的作用.方法采用计算机体层摄影(CT)或磁共振成像(MRI)引导立体定向技术对420例脑深部或脑主要功能区病灶进行了活检手术.其中男252例,女168例,年龄4.5～71岁,平均40.3岁.病变位于脑深部104例,鞍区82例,基底节区78例,三脑室后部50例,多发病灶48例,脑室内23例,小脑半球19例,脑干内14例,斜坡2例.CT引导手术386例,MRI引导手术34例.结果共有405例作出了病理诊断,活检总阳性率为96.43%,其中肿瘤359例(85.48%),炎性病变33例(7.86%),其他病变13例(3.10%).未作出病理诊断者15例(3.57%).共发生手术并发症7例(1.67%)出血5例(1.2%),癫痫1例,意识障碍1例.结论 CT或MRI引导的立体定向脑深部病变活检术是一种明确颅内占位病变的组织学诊断的可靠方法,并能为临床治疗方法的选择提供依据.

Clinical study of CT or MRI-guided stereotaetic biopsy for brain deep lesions.

Objective To evaluate the accuracy of CT or MRI-guided stereotactic biopsy in making correct pathological di- agnosis and choosing corresponding management of brain tumors. Methods Between January 1991 and December 1997, CT or MRI-guided stereotactic biopsies were performed in 420 patients with intracerebral lesions which were deeply located in brain func- tional area. There were 252 males and 168 females. Their ages ranged from 4.5 to 71 years (average 40.3 years). The lesion was located in deep cerebrum in 104 cases, sellar area in 82, basal ganglion in 78, posterior of third ventricle in 50, multiple lesions in 48, intraventricle in23, cerebellum in 19, brain stem in 14 and clivus in 2. CT-guided biopsy was performed in 386 cases and MRI-guided in 34. Results The brain tumors were diagnosed pathologically in 359 cases (85.48%); inflammatory processes in 33(7.86%), other lesions in 13(3.10%) and no diagnosis in 15(3.57%). The over all positive biopsy rate was 96.43% and the positive rate for brain tumor was 85.48%. The complications after biopsy were found in 7 cases (1.67%): intracranial hematoma in 5(1.2%), seizure in 1 and failure in 1. Conclusions The results suggest that CT or MRI-guided stereotactic biopsy is a reliable method for histopathological diagnoses of brain lesions and it is also of great value in selecting appropriate management.