立体定向手术治疗脑深部病变及运动异常(附32例报告)

目的分析立体定向手术对脑深部病变及运动异常的临床应用价值。方法采用CT或MRI定位对脑深部囊性病变进行治疗,对诊断不明确的病变进行活检,对帕金森病、痉挛性脑瘫等运动异常进行射频毁损治疗。结果2例活检的病例均明确了病变性质;随访2~20个月,3例脑深部病变者好转,10例帕金森病患者4例术后震颤、强直消失停用左旋多巴,4例左旋多巴减量至术前1/2~1/3;11例脑瘫及4例特发性震颤患者好转,1例癫痫伴精神症状者无效;无术后昏迷、偏瘫、感染、手术死亡。结论立体定向手术创伤小、安全性高,对脑深部病变的诊断和治疗以及运动异常的治疗有积极应用价值。     

立体定向脑内病灶活检的临床意义

目的 探讨先进图像引导立体定向脑组织活检术方法 ,明确其在神经系统疾病诊断中的意义.方法 回顾性分析1987年12月至2009年1月立体定向脑内病灶活检的1187例病历资料,其中男性694例(58.5%),女性493例(41.5%);年龄1～85岁(平均39.7岁).CT(含正电子发射断层扫描)引导活检607例,MRI(含氢质子磁共振波谱成像)引导活检580例;采用常规框架立体定向活检手术726例,采用无框架立体定向机器人活检手术461例(含定向引导神经内镜活检).早期450例立体定向手术定位,采用CT或MRI图像测量靶点坐标方法 ,不能立体显示穿刺途径;后期737例立体定向手术定位,采用计算机三维重建病灶方法 ,能够立体显示穿刺路径.结果 活检明确组织病理学诊断1156例(活检阳性诊断率97.4%).本组中983例(82.8%)获得肿瘤学病理诊断,主要包括神经胶质瘤、转移性肿瘤、原发性淋巴瘤、生殖细胞瘤等;173例(14.6%)为非肿瘤性病变,其中包括多发硬化和瘤样脱髓鞘病变、神经变性疾病、炎性病变、寄生虫病等.活检穿刺手术并发少量血肿(<10 ml)而无神经功能障碍20例(1.7%),较大血肿(>10ml)需要外科处理(置管引流或开颅血肿清除)9例(0.8%);活检出血导致死亡3例(0.3%).本组无颅内感染病例.结论 先进影像技术引导的立体定向脑组织活检术是一种微侵袭、可靠的脑内疾病确定诊断手段.生化成像、功能成像技术的发展,为立体定向引导的活检技术赋予了崭新的内容.     

弥散性神经胶质瘤病的临床诊断与治疗

目的 提高临床诊断弥散性神经胶质瘤的水平,方法 对4例神经胶质瘤病例的临床症状、体征、MRI进行分析。2例开颅手术,2例CT立体定向活检术,均经病理证实为弥散性神经胶质瘤病。结果 4例均有颅内压增高表现,除1例病灶累及大肠2个脑叶外,其余均累及大脑3个叶,病灶在T1W1均呈低或等信号,在T2W1上呈高信号,局部脑组织肿胀,无坏死囊变及出血,占位效应不明显,增强扫描无明显强化,3例胼胝体肥大增厚,结论 ＭＲＩ有其特有表现。手术或立体定向活检术是确诊该病的最佳选择。确诊后化疗及放疗应作为常规治疗的手段。     

3D Slicer软件在CR型脑外科手术机器人颅内病变活检中的应用

目的探讨3D Slicer软件辅助国产CR型脑外科手术机器人在颅内病变活检组织检查中的应用价值。方法回顾性分析航天中心医院神经外科2019年1月至2021年12月连续收治并采用国产CR型脑外科手术机器人进行颅内病变活检的80例病例资料。男性36例, 女性44例, 年龄(38.5±18.0)岁(范围:6～71岁)。术前仅行T1加权三维磁化强度预备梯度回波序列和弥散张量成像扫描, 收集数据后应用3D Slicer软件重建颅内病变、大脑皮层和血管、白质纤维束的影像, 将CT和MRI数据导入国产CR型脑外科手术机器人工作站, 设计穿刺路径;穿刺病变组织送病理检查, 明确诊断。结果 80例患者的无框架立体定向穿刺活检均成功完成。病理学诊断弥漫性星形细胞瘤和少突胶质细胞瘤50例, 淋巴瘤15例, 转移瘤5例, 炎性脱髓鞘病5例, 炎性肉芽肿2例, 血管瘤1例, 急性淋巴细胞白血病颅内浸润1例, 精原细胞瘤1例, 穿刺活检阳性率100%(80/80)。术后影像学证实穿刺路径和靶点均按术前规划精准实施, 靶点误差为(1.32±0.44)mm(范围:0.55～1.99 mm)。术后发生穿刺靶点无症状渗血...     

立体定向硅胶管置入靶向微创手术治疗颅内微小病变

目的探讨立体定向硅胶管置入靶向微创手术应用于颅内微小病变的临床疗效及手术技巧。方法颅内微小病变共65例患者,随机分为实验组(n=38)和对照组(n=27),实验组为CT引导下立体定向硅胶管置入微创手术治疗,对照组为传统开颅手术,治疗比较两组患者治疗效果。结果实验组病变均定位精确,一次性全切,无死亡病例,对照组死亡1例,在癫痫控制情况、ADL得分、神经功能评分中,实验组较对照组改善更为明显(P0.05)。结论在CT引导下采用立体定向硅胶管置入微创治疗颅内微小病变定位精确,有助于降低手术并发症,能够显著提高患者生活质量,促进术后患者的早期康复。     

脑内小病灶立体定向显微开颅切除术

目的总结立体定向指导下小骨瓣开颅脑内小病灶切除术的经验。方法全部病例均采用驹井式CT脑立体定向仪引导对30例脑内小病灶进行切除。结果30例脑内小病灶立体定向导引切除均得到满意的临床效果,无任何重大并发症,无死亡病例。结论立体定向显微神经外科手术切除颅内病变具有定位精确、损伤小,临床效果明显优于传统开颅,是一种安全和有效的微创手术方法。     

无占位效应颅内肿瘤的诊断治疗

临床上仅有癫痫表现，ＣＴ检查表现为颅内低密度病灶，无强化或强化不明显，无占位效应的脑瘤患者，往往长期被误诊为“病毒性脑炎”，甚至“脑梗塞”或“脑囊虫”病，接受不正确的治疗。我科近一年来收治７例此类患者，所有病例均经ＣＴ导向立体定向活检术确诊，证实为低...     

成人纵隔淋巴结结核影像学表现及病理对照分析

目的总结成人纵隔淋巴结结核的影像学表现特点及其与病理改变的关系,探讨影像学诊断价值。方法回顾分析40例纵隔淋巴结结核病例的临床、CT和MRI检查资料,并与17例术后及淋巴结穿刺活检后病理结果进行对照研究。结果40例中多发淋巴结肿大35例,单发淋巴结肿大5例;病变累及右侧纵隔26例,左侧纵隔13例,双侧同时受累11例。CT平扫肿大淋巴结呈等密度或稍低密度,多数密度均匀,少数较大淋巴结可显示内部稍低密度区;MRI平扫肿大淋巴结呈中等T1、中等T2信号,其内可见斑片状稍长T1、稍长T2信号。CT和MRI增强扫描所见淋巴结强化方式相似,分别为结节状、环状、分隔状及不均匀强化,以环状及分隔状强化具特征性及诊断特异性。与手术及活检病理结果对照显示CT和MRI表现与淋巴结结核各期病理改变相一致。结论CT和MRI均可明确显示纵隔淋巴结结核病变大小、形态、范围及其与周围组织关系,增强扫描可充分反映病变不同时期病理改变,影像学检查在该病的诊断和治疗过程中具有极其重要的应用价值。     

多层螺旋CT与MR对诊断下肢线状骨折的价值

目的:探讨多层螺旋CT与MRI对下肢线状骨折的诊断价值。方法:对40例我院CT与MR诊断线状骨折的资料进行回顾性分析,患者均行X线摄片检查,30例行CT检查(做CT三维重建),10例MR检查,10例同时行CT和MRI检查。结果:所选病例外伤X线首次平片均未显示明确骨折线,30例行CT检查,其中26例均清楚显示骨折线及小骨片;3例未见骨折,1例见线状影,骨折不明确。10例MRI检查,显示骨挫伤9例、骨折9例;1例CT见线状影,MR表现正常。结论:骨外伤影像诊断中,CT与MRI对X线平片不易发现下肢线状骨折有一定价值.     

CT引导下穿刺活检在胸腰椎病变诊断中的应用

目的探讨CT引导下穿刺活检在胸腰椎病变中的应用价值。方法对12例诊断不明确的胸腰椎疾病的患者运用CT引导下经皮穿刺活检的方法进行病理诊断,其中男8例,女4例,年龄12-84岁,平均45岁。分析穿刺活检的准确性、安全性。结果12例均穿刺成功,其中1例取材不满意,取材满意率为91.6％。无轻微及严重并发症发生。12例均有手术病理结果,其中10例穿刺结果和手术结果相符,穿刺活检准确率为90.9％。结论CT引导下穿刺活检为一项创伤小,准确率高,并发症少的微创检查,在脊柱疾病的诊断中有很大的应用价值。     

MRI-guided stereotactic biopsy in the diagnosis of glioma: comparison of biopsy and surgical resection specimen

BACKGROUND: Although there has been a dramatic increase in the accessibility and utilization of high-resolution MRI techniques for the evaluation of brain tumors, there is currently only a single report comparing stereotactic brain biopsy specimen to subsequent resection specimen exclusively in the management of gliomas. METHODS: The diagnoses in 43 cases of astrocytic brain tumors were derived using MRI-guided stereotactic biopsy followed by open resection of the lesion. The histologic diagnoses yielded by biopsy were compared with subsequent histologic diagnosis after open tumor resection. All biopsies and histologic diagnoses were made by the same surgeon and pathologist, respectively. RESULTS: In 23 patients undergoing resection <60 days after biopsy, the biopsy diagnosis was consistent with resection diagnosis in 18 cases (79%) and led to the correct treatment in 22 cases (96%). Recurrent glioblastoma multiforme (GBM) was undergraded as anaplastic astrocytoma in 4 patients. GBM was misdiagnosed as radiation necrosis in 1 patient. MR-nonenhancing lesions [10/10 (100%)] yielded histology that correlated with subsequent craniotomy, while only 8/13 (61%) MR-enhancing lesions yielded histology that was consistent with that at craniotomy (p < 0.05). In 20 patients undergoing resection because of radiologic tumor progression (mean 7 months after biopsy), 6/6 (100%) biopsy diagnoses of a specific glioma grade correlated with resection diagnosis, while only 6/14 (43%) biopsy diagnoses of radiation effect correlated with resection diagnosis (p < 0.01). CONCLUSION: MRI-guided stereotactic brain biopsy specimen accurately represents the grade of the larger glioma mass sufficiently to guide subsequent therapy. Enhancement on MR may be a negative prognostic indicator of biopsy accuracy.     

Primary germinoma arising from the midbrain

Summary A 29-year-old man presented with diplopia, dysarthria, anisocoria, oculomotor nerve paralysis, abducens nerve paralysis, right facial palsy, and spastic hemiparetic gait. Magnetic resonance imaging (MRI) showed a homogenously enhanced mass in the midbrain. MRI-guided stereotactic biopsy was performed, and the histologic diagnosis was pure germinoma. The tumor disappeared after chemotherapy and radiotherapy. Germinoma should be included in the differential diagnosis of midbrain lesions in young adults. MRI-guided stereotactic biopsy provided a helpful diagnostic clue in a patient with a midbrain lesion.     

钆塞酸二钠增强MRI引导肝脏病灶穿刺活检的可行性

目的 观察钆塞酸二钠（Gd-EOB-DTPA）增强MRI用于引导肝脏病灶穿刺活检的可行性。方法 对15例肝脏病变患者行Gd-EOB-DTPA增强MRI引导下穿刺活检,统计总操作时间及技术成功率（以取样标本满足病理、基因等检测要求为技术成功）,观察术中及术后并发症。以手术病理或随访结果为标准,评估MRI引导肝脏病灶穿刺活检的诊断效能。结果 于Gd-EOB-DTPA增强MRI引导下穿刺15个肝脏病灶,均一次穿刺成功,病灶最大径0.40~2.81 cm,平均（1.58±0.69） cm;肝胆期MRI 13个病灶呈明显低信号、2个呈稍低信号,图像质量均满足操作要求;技术成功率100%（15/15）;总操作时间33~54 min,平均（40.33±6.56） min。5例术中见少量针道渗血,沿针道推入明胶海绵条后止血;其余10例术中、术后均未出现并发症。穿刺标本病理诊断10例肝细胞癌（HCC）、1例结肠癌肝转移、1例肝腺瘤及3例肝脏不典型增生结节伴轻度肝硬化,其中1例穿刺病理结果为肝脏不典型增生结节伴轻度肝硬化者术后病理结果为早期小HCC,其余穿刺病灶病理诊断均与最终临床诊断一致。MRI引导肝脏病灶穿刺活检的诊断敏感度为91.67%（11/12）,特异度为100%（3/3）,准确率为93.33%（14/15）。结论 Gd-EOB-DTPA增强MRI用于引导肝脏病灶穿刺活检安全、可行。     

Magnetic resonance imaging-guided core needle biopsy and needle localized excision of occult breast lesions.

BACKGROUND: Breast magnetic resonance imaging (MRI) has been reported to be twice as sensitive and three times more specific in detecting breast cancer. We report a series of MRI-guided stereotactic breast biopsies (SCNBB) and needle localized breast biopsies (NLBB) to evaluate MRI as a localization tool. METHODS: Forty-one breast lesions were identified in 39 patients who subsequently had SCNBB or NLBB. Suspicious areas of enhancement were stereotactically biopsied with 16-G core biopsy needles or localized with 22-G wires for excision under laser guidance. RESULTS: Forty-one breast lesions were identified from 1,292 breast MRIs. SCNBB identified three malignancies and two areas of atypia. Two additional cancers were found after NLBB. In patients having NLBB alone, five cancers and two areas of atypia were identified. CONCLUSIONS: In this initial series, breast MRI-guided SCNBB and NLBB were valuable tools in the management of patients with suspicious abnormalities seen only on MRI.     

MRI-guided stereotactic brain biopsy: a review of 33 cases

MRI is being increasingly used for the detection of intracranial lesions. MRI-guided stereotactic brain biopsy is infrequently performed. We audited our recent experience of this procedure, and demonstrated that it is feasible and comparable to CT-guided biopsy in terms of diagnostic accuracy with a low procedural morbidity. We critically analyse its future role in the presence of more recent developments.     

MRI引导下乳腺病灶真空辅助穿刺活检术的应用

目的探讨MRI引导真空辅助穿刺活检术在BI-RADS 4类乳腺病变中的应用价值。方法对9例MRI诊断为BI-RADS 4类乳腺病变的患者行MR引导真空辅助穿刺活检术。采用1.5T MR仪,8通道专用乳腺MR活检线圈,乳腺适度加压后固定于定位装置内;定位扫描采用矢状位3D动态增强扫描,将数据传至乳腺活检专用定位工作站,由工作站自动计算活检位置及进针深度。以14.5cm、8G真空辅助活检针进行穿刺。结果 9例中,8例病灶准确定位,并成功取得组织病理结果;1例因病灶位置表浅、工作站不能定位而终止活检。每例取组织6~20条,共取96条;每例操作时间为30~65min。组织病理学结果:乳腺浸润性导管癌2例,腺病3例,导管内乳头状瘤1例,硬化性腺病合并导管扩张1例,腺病伴不典型增生1例。结论 MR引导下乳腺病变真空抽吸活检术用于BI-RADS 4类乳腺病变安全可行,能够取得足够的组织用于病理学评估。     

Importance of image-guided stereotactic biopsy to confirm diagnosis in an oncological setting

Background: In current practice, the neurosurgical community relies heavily on computed tomography (CT) and magnetic resonance imaging (MRI) for making the diagnosis of brain lesions, especially when surgically inaccessible. However, the specificity of these neuroimaging modalities remains limited, and errors in diagnosis are frequent. In an attempt to ascertain how often the diagnosis based on imaging studies is proved wrong by biopsy, we reviewed the findings from 100 consecutive stereotactic biopsies performed in an oncological setting. Method: The records of 100 consecutive stereotactic biopsies were postoperatively reviewed. The preoperative clinical and radiologic differential diagnoses were compared with diagnosis made on tissue retrieved by biopsy. Results: In 19% of patients, the preoperative clinical and radiological diagnoses and postoperative diagnosis were different, and reliance on brain imaging data alone would have led to an incorrect tentative diagnosis and the wrong choice of treatment. Conclusions: The high rate of discrepancy between clinical and radiological diagnoses on the one hand and biopsy-proven diagnosis on the other hand is a compelling reason to establish tissue diagnosis. Stereotactic biopsies of brain lesions are relatively safe and should be performed in cases where tissue characteristics affect prognosis, where therapy carries an inherent risk, and in those patients under treatment for cancer or immune deficiencies in whom there is an unusually broad differential diagnosis.     

Is it appropriate to redefine the indication for stereotactic brain biopsy in the MRI Era? Correlation with final histological diagnosis in supratentorial gliomas.

BACKGROUND: The aim of this study was to evaluate the advisability of modifying the indications for stereotactic brain biopsy (SBB) in high- and low-grade supratentorial glial tumors in correlation with the diagnostic accuracy of magnetic resonance imaging (MRI). MATERIALS AND METHODS: We analyzed 174 cases of supratentorial glial lesions diagnosed by MRI before biopsy. On the basis of the MRI findings the patients were divided into two groups: high-grade (n=107) and low-grade (n=67) gliomas. All patients underwent CT-guided biopsy. Only one preoperative diagnosis was allowed. RESULTS: A final histological diagnosis was achieved in 95% of the 174 cases. In the group of high-grade gliomas (HGG) there was diagnostic coincidence in 87% of cases, reaching 100% in lesions of the corpus callosum. In 11 cases (10%) the histological analysis changed the presumptive diagnosis and the consequent management. In the group of low-grade gliomas (LGG) there was diagnostic coincidence in 63% (42 cases), whereas there was discordance in 30%: 10 cases were upgraded to anaplastic astrocytoma, and in 10 cases no tumors were observed at all. CONCLUSIONS: In the future, the histological diagnosis of glial tumors will include molecular genetic definition, thus making it crucial for management using the new therapeutic options. Today, the indications for biopsy in lesions mimicking high-grade gliomas are mainly linked to the site of the tumor, coexisting differential diagnoses or more than one treatment option. In lesions of the corpus callosum, histological analysis seems not to be required in order to proceed to complementary therapies. On the contrary, in lesions where MRI findings indicate low-grade gliomas, grading is crucial also in order to avoid treatment inappropriate in non-neoplastic lesions.     

Significance of Papillary Lesions at Percutaneous Breast Biopsy

Background The management of nonpalpable papillary lesions found in specimens obtained by percutaneous breast biopsy is controversial. We reviewed the treatment of patients found to have papillary lesions by stereotactic, sonographic, or fine-needle aspiration breast biopsy to identify indications for surgical excision. Methods Consecutive patients with intraductal papilloma, atypical papilloma/papilloma with atypical ductal hyperplasia, papillary neoplasm, and papillomatosis according to percutaneous breast biopsy were identified from radiology records. The charts were reviewed to identify patients who had subsequent surgical excision, and the pathologic findings were correlated with the biopsy method and indications for surgery. Results Papillary lesions were found in 120 biopsy samples from 109 patients. Malignancy was found at operation in 19 (24%) of 80 lesions that underwent surgical excision: 12 (63%) were ductal carcinoma-in-situ, 4 (21%) were infiltrating ductal carcinoma, 2 (11%) were infiltrating papillary carcinoma, and 1 (5%) was intracystic papillary carcinoma. Malignancy was found in 9 (30%) of 30 fine-needle biopsy papillary lesions, 6 (35%) of 17 core biopsy papillary lesions, and 4 (12%) of 33 stereotactic biopsy papillary lesions. Malignancy was missed significantly less frequently with stereotactic biopsy (P < .05). Conclusions Malignancy is frequently found at surgical excision for papillary lesions found on percutaneous breast biopsy. Malignancy is missed significantly less frequently with stereotactic biopsy.