影像学引导的立体定向脑活检手术

目的探讨现代神经成像技术(CT、MRI)引导的立体定向脑病变活检术对组织病理学诊断的可靠性和正确性,总结手术操作方法和技术要点。方法采用CT、MRI与立体定向技术相结合,进行脑部病变的活检手术共605例,其中450例用CT或MRI片目测靶点坐标定位,155例采用计算机辅助的立体定向手术(CAPN)工作站,自动计算靶点和规划活检入路。结果522例确诊为各种脑肿瘤,39例为炎性病理,23例为寄生虫或先天性囊肿,16例未能提供可供确诊的病理,阳性诊断率为97.36%。并发症15例,其中2例死亡。结论先进影像技术引导下的立体定向脑病变活检术是神经内、外科脑部病变获得定性诊断安全、可靠的手术方法。术中应注意改进操作方法,以提高病理诊断的阳性率,并达到微侵袭性手术的要求。     

立体定向脑病变活检术28例临床分析

目的分析研究MRI引导下的立体定向技术对脑部病灶行立体定向活检术病理诊断结果,探讨手术方法与技巧。方法使用Leksell立体定向定位头架,在MRI引导下行立体定向穿刺活检。结果活检术后病理胶质瘤13例,淋巴瘤5例,脑转移癌3例,炎性病变4例,寄生虫2例,胶质增生1例。活检总阳性率96.43%。并发颅内出血1例(3.57%),癫痫发作1例(3.57%),无死亡病例。结论脑立体定向活检术安全、高效为下一步治疗提供可靠的病理学证据。     

脑深部病变立体定向活检方法的临床研究

１９９１年１月至１９９６年１２月采用ＣＴ引导立体定向技术对３８６例脑深部和脑功能区病灶进行了活检手术，男２３２例，女１５４例，年龄４．５￣７１岁，平均４０．５％岁。病变位于离深部９０例，鞍区７４例，基底节区７３例，三脑室后部４６例，多发病灶４５例，脑室内４５例，脑２３例，小脑半球１９例，脑干内１４例，斜坡２例。结果共有３７２例作出了病理诊断，活检阳性率为９６．３７％，其中肿瘤３２７例（肿瘤检出率８     

CT引导下脑立体定向活检术

采用立体定向行脑组织活检，最初系Spiegel与Wycis应用于非肿瘤性病变，于立体定向丘脑手术治疗运动障碍性疾病时，在皮质目标区获取少数脑组织作为组织学和组织化学检查。1976年Bergstrom和Greitz等首先报道CT定向方法进行脑肿瘤活检获得成功。近20年来，随着影像学、计算机技术的发展，使CT引导下脑立体定向活检术更加普及，在很大程度上有助于对颅内病变的诊断和治疗。     

CT引导立体定向脑深部病变活检术（附310例报告）

１９９１年１月至１９９５年９月采用ＣＴ引导立体定向技术对３１０例脑深部或脑功能区病灶进行了活检手术。病变位于鞍区６２例，基底节区５１例，第三脑室后部３８例，大脑半球深部７４例，脑室内２１例，颅内多发性病灶３８例，脑干内９例，小脑半球１７例。活检总阳性率为９６％，肿瘤检出率为８５．８％。５例并发颅内出血（１．６１％）。认为ＣＴ引导的立体定向脑深部病变活检是一种明确颅内占位病变的组织学诊断并利于采取最佳治疗措施的最可靠的方法。     

脑深部病变立体定向活检方法的临床研究

１９９１年１月至１９９６年１２月采用ＣＴ引导立体定向技术对３８６例脑深部和脑功能区病灶进行了活检手术，男２３２例，女１５４例，年龄４．５～７１岁，平均４０．５岁。病变位于脑深部９０例，鞍区７４例，基底节区７３例，三脑室后部４６例，多发病灶４５例，脑室内２３例，小脑半球１９例，脑干内１４例，斜坡２例。结果共有３７２例作出了病理诊断，活检阳性率为９６．３７％，其中肿瘤３２７例（肿瘤检出率８４．７２％），炎性病变３２例（８．２９％），其它病变１３例（３．３７％）。未作出病理诊断者１４例（３．６３％）。发生手术并发症７例（１．８１％）：出血５例（１．３％），癫痫１例，中止手术１例。认为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。文章还对立体定向活检术的并发症及预防，如何提高阳性率等问题进行了讨论     

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.     

脑内病变MRI定位立体定向活检术33例

目的 总结脑内病变MRI定位立体定向活检术的经验。方法 2005年1月至2014年9月收治33例临床诊断困难的脑内病变患者,其中幕上病变31例,幕下病变2例,颅内多发性病灶19例;均在MRI引导下行立体定向活检术。结果 病理学诊断结果示胶质瘤13例,非何杰金氏淋巴瘤4例,转移瘤1例,炎性病变6例,结核性肉芽肿3例,真菌感染2例,神经变性2例;不能明确诊断2例,考虑胶质细胞增生。本组阳性诊断率为94.1%（31/33）。术后发生取材区非症状性出血2例,症状性出血1例;死亡1例。结论 MRI定位立体定向活检术是脑内病变诊断的重要方法,有效提高疑难病例的病理诊断成功率。     

三维可视化手术规划系统引导立体定向脑活检术的临床应用

目的 探讨三维可视化手术规划系统引导立体定向脑活检术的临床应用价值。方法 回顾性分析2019年3月至2020年4月收治的10例脑内病变的临床资料,均在三维可视化手术规划系统引导下进行立体定向脑活检术。结果 病变位于额叶2例、颞叶2例、胼胝体2例、脑干及丘脑3例,多发病灶1例。术后病理结果显示胶质母细胞瘤2例,间变星形细胞瘤2例,弥漫型星形细胞瘤3例,弥漫性大B细胞淋巴瘤3例。术后复查头颅CT未见出血。结论 三维可视化引导立体定向脑活检手术,手术创伤小,穿刺路径可规划,可控制,提高了脑活检术的安全性。     

微侵袭立体定向活检方法的研究

目的 评价微侵袭立体定向活检术在确定脑深部的主要功能区病变的病理组织学诊断中的作用。方法 在近10年立体定向手术经验的基础上,将微侵袭观点引入立体定向活检手术并对155例脑深部或主要功能区病变进行了活检手术研究。其中男89例,女66例,年龄自6.5-68岁,平均31.3岁。行CT引导的立体定向活检43例,MRI引导112例。结果 组织病理学诊断结果为脑肿瘤118例,炎性疾病15例,寄生虫或囊肿样病变10例,放射怀坏死6例,脑变性性疾病3例,3例未能获得阳性病理学诊断,总阳性诊断率为98.1%。共发生并发症4例。无死亡发生。结论 立体定向活检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。微侵袭技术的引入则可提高活检的阳性率并能降低并发症的发生率。     

Stereotactic biopsy of brain tumours in the paediatric population

Objective Our objective was to establish the role of stereotactic neurosurgical techniques in the management of brain tumours in children.Materials and methods A retrospective analysis was conducted of all stereotactic procedures performed in a single centre between 1996 and 2001. The success rates of achieving histologic diagnosis and a correlation between radiologic and histologic diagnosis were examined.Results There were 7 boys and 7 girls with a mean age of 9.1 years (range: 4–15). Under general anaesthetic 15 procedures were performed in 14 patients: 12 diagnostic and 3 therapeutic; 10 with CT and 5 with MRI guidance; 10 lesions were supratentorial and 4 were in the pons. A definitive histologic diagnosis was established in 10 of the 12 cases (diagnostic yield 83%). The pre-operative radiological diagnosis was accurate for tumour type in only 75% of the cases. In 3 patients cyst aspiration was attempted: post-operatively the cyst size was decreased in 2 and unchanged in 1. Seizures and acute confusion following biopsy of a thalamic tumour occurred in 1 patient. Post-operative scans were performed in 7 patients and in 2 we noted small, clinically insignificant, haemorrhages at the biopsy site. There was no mortality and morbidity was 6.6%.Conclusions This small series confirms that stereotactic procedures in children are safe, well tolerated, with a high diagnostic yield, which could be improved with the use of intraoperative histopathological examination.     

CT-guided stereotactic biopsies of brain stem lesions: personal experience and literature review

Abstract. Appropriate therapy of brain stem lesions should be guided by an accurate diagnosis. Clinical evaluation combined with modern neuroimaging techniques may nowadays approach the diagnosis but not always with accuracy, thus leading to erroneous treatment. We report a series of 11 patients who underwent stereotactic biopsy for brain stem lesions. In 8 patients, the lesion was approached transfrontally. In the remaining 3 patients, the lesion was approached via the suboccipital transcerebellar route. There was no surgical mortality. Precise histological diagnosis was achieved in all patients. Three patients (27.2%) suffered complications attributed to the procedure and were successfully treated conservatively. Histological results were in accordance with preoperative diagnosis in 9 patients (81.8%). Despite the limited number of patients, our data suggest that stereotactic biopsy of brain stem lesions is a safe technique that can obtain adequate tissue for histological diagnosis, thus providing each patient with the best available treatment.     

Stereotactic brain biopsy in AIDS

Summary In the hope of finding a treatable condition, the need for rapid diagnosis in HIV-seropositive patients with brain lesions is apparent. In order to evaluate the efficacy of stereotactic brain biopsy in AIDS patients, we retrospectively studied 25 HIV-infected patients undergoing stereotactic biopsy. Brain lesions were identified with gadolinium-enhanced MRI and/or contrastCT. Brain biopsy was performed using the system of Riechert. From 8 up to 15 small tissue samples from one or two targets were obtained in every patient. The biopsy material was examined cytologically, histologically (including electron microscopy), immunohistochemically and, in part, by animal test and polymerase chain reaction (PCR). A definite diagnosis was achieved in 92%. Diagnosis included primary central nervous system lymphoma (PCNSL) (10), toxoplasmosis (10), progressive multifocal leukoencephalopathy (2) and one case of co-existing toxoplasmosis and cytomegalovirus infection. Two biopsies were non-diagnostic. All PCNSLs showed polymorphic B-cell populations of high malignancy; accurate classification according to the Kiel classification was not possible. In 3 lymphomas Epstein-Barr nuclear antigen (EBNA) 2-mRNA could be detected by PCR and confirmed immunohistochemically by EBNA 2 expression. In 6 cases autopsy confirmed the biopsy diagnosis. Conventional histology was not sufficiently decisive for toxoplasmosis and progressive multifocal leukoencephalopathy, so that immunohistochemistry and animal tests became very important for a final diagnosis. With the help of different morphological and molecular biological techniques stereotactic brain biopsy appears to be an effective method in the diagnosis of HIV-associated brain lesions. In view of the marked radio- and chemosensitivity of PCNSLs it is mandatory to establish an early and accurate histological diagnosis for adequate treatment.     

Stereotactic surgery in the management of deep intracranial lesions in infants and adolescents

Over a period of 5 years, 34 pediatric patients underwent stereotactic surgery for deep-seated brain lesions: 32 patients proved to have a brain tumor, and in 2 cases the lesion was not tumoral; 15 patients with low-grade astrocytomas were treated with ¹²⁵I interstitial radiotherapy. The importance of stereotactic surgery is emphasized because of its relative safeness, diagnostic reliability, and the possibility of eventual brachytherapy.     

立体定向活检术结合伽玛刀治疗脑深部胶质瘤

目的探讨立体定向活检术结合伽玛刀治疗脑深部胶质瘤的效果。方法利用立体定向活检术明确病灶性质后,伽玛刀治疗脑深部病灶26例,伽玛刀治疗剂量18-25Cy。结果26例脑深部病灶立体定向活检术后病理学诊断为胶质瘤;伽玛刀治疗后半年实体肿瘤控制有效率达88．5％（23／26）。结论对无明显颅内压增高的脑深部胶质瘤患者,立体定向活检术明确肿瘤性质后,减少手术带来的并发症;对体积稍大者采用剂量分割方法以提高肿瘤的处方剂量,从而使肿瘤控制率达到较好的水平。     

Stereotactic brain biopsy: Single center retrospective analysis of complications

Objective

Stereotactic biopsy is a widely used surgical technique for the histological diagnosis of intracranial lesions. Potential risks of this procedure, such as hemorrhage, seizure, and infection have been established, and different risk factors have been characterized. However, these risks have been addressed by only few studies conducted in Asian countries.

Materials and methods

The study group is comprised of 299 consecutive stereotactic biopsy procedures by 11 neurosurgeons between 2004 and 2007. The pre-operative medical conditions, methods of biopsy and postoperative complications were analyzed.

Result

The overall diagnostic yield was 90.64%. Complications were observed in 7.36% of the cases, with symptomatic hemorrhages occurring in 4.35% of the cases, and the overall mortality rate in this study population was 1.34%. Patients with liver cirrhosis were at a higher risk of hemorrhage. Other clinical, radiological, or histological variables were not associated with an increased risk of complications.

Conclusion

Stereotactic brain biopsy is a safe and reliable way to obtain a histological diagnosis. Based on our recent clinical experiences, the data suggests that more attention should be paid to liver cirrhotic patients, since the chance on hemorrhage is significantly larger.     

颅内多发病灶的立体定向活检术后病理学结果与MRS结果的比较分析

目的探讨立体定向活检术及磁共振波谱成像（MRS）在颅内多发病灶定性诊断中的临床价值。方法回顾性分析37例经MRI、MRS和立体定向活检术后病理学检查确诊的颅内多发病灶患者的临床资料,其中行有框架定向活检术22例,无框架神经导航定向活检术15例。结果 37例均获得明确病理学诊断,其中低级别胶质瘤19例,高级别胶质瘤8例,淋巴瘤3例,多发脱髓鞘3例,炎性病灶2例,转移癌2例。术后出现癫痫发作1例,活检靶点少量出血1例。病理学诊断与MRS诊断符合率为83.8%（31/37）,误诊率为16.2%（6/37）。结论 MRS在颅内多发病灶的诊断中具有较高的准确性,但仍有一定的误诊率;立体定向活检术微创、安全,在颅内多发病灶的诊断中具有决定性的意义;MRS的代谢变化在活检术靶点选择上具有一定的指导价值。