MRI导向立体定向活检手术在颅内疑难病例诊断中的应用

目的 探讨MRI导向立体定向活检手术的准确性及其在颅内疑难病例诊断中的应用价值。方法 安装CRW立体定向框架,采用MRI容积扫描与多层重建技术,对26例临床表现不典型或CT扫描不能发现明确病灶的患者施行立体定向脑活检手术。结果 26例患者均未出现因活检手术而造成的出血、偏瘫等严重并发症。所有患者均得到明确的病理诊断及相应的治疗。结论 MRI导向立体定向活检手术在准确性上明显优于CT导向活检手术;对于颅内疑难病例的诊断,也是一种有效的手段。     

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。     

立体定向神经内镜血肿清除术治疗高血压脑出血效果观察

目的 探讨立体定向神经内镜血肿清除术治疗高血压脑出血(HICH)的效果.方法 回顾性分析郑州市第二人民医院2018-08—2020-01间收治的72例HICH患者.依据治疗方案分为立体定向血肿穿刺引流术组(穿刺引流组)和立体定向神经内镜血肿清除术组(血肿清除组),各36例.比较2组患者的基线资料、血肿清除率、手术时间,...     

超声引导用18G自动活检针经皮活检肝内小病变

目的 评价超卢引导经皮活检诊断肝内小的(≤3 cm)局灶性病变的准确性.方法 从2000-2006年共190例病人193个肝内小病灶通过肝活检来明确病变的性质,病灶平均大小为(2.3±0.7)cm(0.6～3 cm),肝内病灶直径≤1 cm 22个,1.1～2 cm 74个,2.1～3 cm 97个,活检全部采用自动活检枪,配18G活检针,采用超声引导下徒手穿刺技术.结果 没有并发症发生,有187例(98.4%)取样足够用于诊断,组织病理学诊断结果包括恶性肿瘤149例.良性肿瘤19例,非肿瘤性病变22例.诊断敏感性为98.0%,特异性为100%,阳性预测值为100%,阴性预测值为92.7%,准确性为98.4%.结论 超声引导经皮活检对于诊断肝内小的病变具有相当高的准确性和安全性.     

锥体束CT引导下纵隔占位性病变穿刺活检的临床应用

目的探讨锥体束CT(CBCT)引导下穿刺活检纵隔占位性病变的可行性及安全性。方法回顾性分析31例纵隔占位性病变患者的资料。与临床最终诊断结果对照,评价CBCT引导下纵隔占位性病变穿刺活检的诊断效能,并分析穿刺相关并发症情况。结果对31例患者共行穿刺活检31次,技术成功率100%(31/31)。30例穿刺病理结果与临床最终诊断结果一致,1例穿刺病理检查未能定性。CBCT引导下穿刺活检的诊断敏感度、特异度及准确率分别为96.30%(26/27)、100%(4/4)和96.77%(30/31)。本组出现气胸、血胸各1例,并发症发生率为6.45%(2/31)。结论 CBCT引导下穿刺活检定性诊断纵隔占位性病变准确率较高,且并发症较少。     

高分辨率微细血流成像引导术前经皮穿刺活检

目的分析高分辨率微细血流成像(HDMFI)引导穿刺活检的临床价值。方法回顾性分析46例经手术切除病灶并明确病理诊断的单发占位病变患者,病灶位于浅表31例、腹腔8例、盆腔7例;术前接受超声引导下穿刺活检,最大径<1 cm者接受细针穿刺,≥1 cm者接受粗针活检,其中25例以常规CDFI(CDFI组)、21例以HDMFI靶向引导穿刺(HDMFI组);对比2组取材成功率、诊断符合率及穿刺并发症。结果对CDFI组共行细针活检16例、粗针活检9例,穿刺61次,其中52次取材成功,22例获得明确病理诊断;HDMFI组细针活检15例、粗针活检6例,穿刺48次,46次取材成功,20例获得明确病理诊断。CDFI组穿刺活检取材成功率、诊断符合率分别为85.25%(52/61)、88.00%(22/25),HDMFI组分别为95.83%(46/48)、95.24%(20/21),HDMFI组均高于CDFI组(P均<0.01)。术中及术后均未见穿刺并发症。结论 HDMFI可清晰显示病灶内部微细血流灌注,用于精准引导穿刺效果较CDFI更佳。     

超声弹性成像、X 线钼靶与超声引导下穿刺活检在BI-RADS4类乳腺肿块鉴别诊断中的价值评估

目的:探讨超声弹性成像、X线钼靶与超声引导下穿刺活检在BI-RADS4类乳腺肿块鉴别诊断中的价值。方法:采用回顾性调查方法,对2016年8月—2018年2月手术且病理证实的82例84个乳腺病灶的术前超声弹性成像、X线钼靶与超声引导下穿刺活检结果进行分析,比较超声弹性成像、X线钼靶与超声引导下穿刺活检的良恶性诊断效能。结果:在84个BI-RADS4类乳腺肿块病灶中,恶性48个,良性36个。超声弹性成像的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值、漏诊率、误诊率分别为95.8%(46/48)、94.4%(34/36)、95.2%(80/84)、95.8%(46/48)、94.4%(34/36)、4.17%(2/48)、5.56%(2/36);X线钼靶分别为91.7%(44/48)、88.9%(32/36)、90.5%(76/84)、91.7%(44/48)、88.9%(32/36)、8.33%(4/48)、11.1%(4/36);超声引导下穿刺活检分别为97.9%(47/48)、100.0%(36/36)、98.8%(83/84)、100.0%(47/47)、97.3%(36/37)、2.08%(1/48)、0.00%(0/36)。三种检测方式的诊断效能差异无统计学意义(P0.05),但超声引导下穿刺活检对乳腺病灶定性诊断具有绝对优势。结论:超声引导下穿刺活检在BI-RADS4类乳腺肿块鉴别诊断中的价值最高。     

超声造影定向活检技术在前列腺癌二次穿刺中的应用研究

目的本研究旨在研究超声造影(contrast-enhanced ultrasound,CEUS)技术在前列腺特异性抗原(prostate-specific antigen,PSA)水平持续升高(4 ng/ml≤PSA10 ng/ml)以及之前经直肠超声(trans-rectal ultrasound,TRUS)引导下随机活检阴性患者中检测前列腺肿瘤病灶的作用。方法本实验纳入180个受试者。A组患者再次给予前列腺穿刺活检,B组患者给予CEUS穿刺活检。结果在第二次活检中,在A组90例中发现前列腺腺癌组织学诊断的共有20例(22.2%),在B组90例中共发现43例(47.8%)(P0.01)。CEUS穿刺活检敏感性为93.2%,特异性为89.2%,阳性预测值(positive predictive value,PPV)为86.6%,阴性预测值(negative predictive value,NPV)为94.0%,准确性为91%。结论在先前经TRUS引导下穿刺活检阴性患者中,CEUS穿刺活检显示出了指导癌症病灶活检的潜力,CEUS定向活检技术可增加前列腺癌的检出率。     

螺旋CT引导下经皮细针活检诊断肾脏小包块(≤4 cm)的准确性和临床作用

作者评价在螺旋CT引导下应用经皮细针活检诊断 4cm的肾脏实性包块的准确性和临床作用。对平均年龄为6 1岁的 88例患者进行诊断性穿刺 ,肿瘤直径平均为 2 .8cm ,采用 18号穿刺针在螺旋CT引导下进行经皮肿瘤穿刺活检。结果 :3例 (3.4 % )穿刺活检组织较少 ,难以用来分析 ;5例 (5 .6 % )活检结果提示纤维化不能明确诊断 ;14例(15 .9% )活检结果为良性病变 ;其余 6 6例为恶性病变 ,其中包括 6 5例肾细胞癌和 1例淋巴瘤。共 6 2例进行手术治疗。统计表明 ,4 2例 (4 7.8% )通过细针穿刺活检改变了治疗方案 ,避免了根治性肾切除 ,其中 13例不需…     

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。     

Stereotactic biopsy for intracranial space-occupying lesions: clinical analysis of 550 cases.

OBJECT: To investigate the role of stereotactic biopsy in planning the optimal management of intracranial space-occupying lesions. PATIENTS AND METHODS: Between December 1989 and December 1999, stereotactic biopsy was performed in 550 patients with intracranial mass lesions that were deep-seated or located in the functional area. There were 340 males and 210 females, and their ages ranged from 4 to 75 years. All the procedures were done under local anesthesia with a Leksell stereotactic system. A CT scan was used to determine the coordinates in the first 420 cases and the Aero Tech Stereotactic Surgical Plan System in the subsequent 130 patients. RESULTS: Brain tumors were diagnosed pathologically in 475 patients (86.4%), inflammatory process in 44 (8.0%), other lesions in 12 (2.2%) and no conclusive diagnosis was found in 19 (3.4%). The overall positive rate of biopsy was 96.6%, and the positive rate for brain tumor was 86.4%. Intracranial hematomas after biopsy were found in 13 cases (2.4%). Seizures occurred during the operation in 7 cases (1.2%), and slight and transient neurological deficits were found in 23 cases (4.2%). There were no deaths or other serious complications. CONCLUSIONS: The results suggest that the stereotactic biopsy is a reliable method to obtain histopathological diagnosis of intracranial mass lesions, and it is also of great help in selecting the appropriate management.     

CT-guided stereotactic neurosurgery

Brown-Roberts-Wells stereotactic instruments were used for CT guided stereotactic surgery in 54 cases (65 operations). Stereotactic biopsy was done in 9 cases and successive regional chemotherapy was done in 3 cases. Stereotactic drainage was done in 2 cases of bacterial abscess, 3 cases of cystic neoplasm and 33 cases (43 operations) of intracerebral hematoma. CT guided stereotactic procedure was valuable for the correct cannulation to the center of the cavity. We tried to utilize CT image for the selection of targets for stereotactic functional neurosurgical procedures in 6 cases. In the cases of thalamotomy, the information derived from CT made the operation safer than that by contrast ventriculography alone. In all cases of electrode implantation for deep brain stimulation, accurate and precise electrode placement was achieved from CT images alone. This rapid and easy surgical technique was useful also for poor risk patients.     

Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases.

OBJECT: The goal of this study was to develop and assess the use and limitations of performing brain biopsy procedures by using image-guided surgical navigation systems (SNSs; that is, frameless stereotactic systems) with scalp-applied fiducial markers. METHODS: Two hundred eighteen percutaneous brain biopsies were performed in 213 patients by using a frameless stereotactic SNS that operated with either sonic or optical digitizer technology and scalp-applied fiducial markers for the purpose of registering image space with operating room space. Common neurosurgical and stereotactic instrumentation was adapted for use with a localizing wand, and recently developed target and trajectory guidance software was used. Eight (3.7%) of the 218 biopsy specimens were nondiagnostic; five of these (2.4%) were obtained during procedures in 208 supratentorial lesions and three were obtained during procedures in 10 infratentorial lesions (30%; p < 0.001). Complications related to the biopsy procedure occurred in eight patients (seven of whom had supratentorial lesions and one of whom had an infratentorial lesion, p > 0.25). Five complications were intracerebral hemorrhages (two of which required craniotomy), two were infections, and one was wound breakdown after instillation of intratumoral carmustine following biopsy. There were only three cases of sustained morbidity, and there were two deaths and one delayed deterioration due to disease progression. Two surgeons performed the majority of the procedures (193 cases). The three surgeons who performed more than 10 biopsies had complication rates lower than 5%, whereas two of the remaining four surgeons had complication rates greater than 10% (p = 0.15). Twenty-three additional procedures were performed in conjunction with the biopsies: nine brachytherapies; five computer-assisted endoscopies; four cyst aspirations; two instillations of carmustine; two placements of Ommaya reservoirs; and one craniotomy. CONCLUSIONS: Brain biopsy procedures in which guidance is provided by a frameless stereotactic SNS with scalp-applied fiducial markers represents a safe and effective alternative to frame-based stereotactic procedures for supratentorial lesions. There were comparable low rates of morbidity and a high degree of diagnostic success. Strategies for performing posterior fossa biopsies are suggested.     

Image-guided frameless stereotactic biopsy sampling of parasellar lesions. Technical note

Interactive image-guided neuronavigation was used to obtain biopsy specimens of cavernous sinus (CS) tumors via the foramen ovale. In this study the authors demonstrated a minimally invasive approach in the management of these lesions. In four patients, whose ages ranged from 29 to 89 years (mean 61.2 years) and who harbored undefined lesions invading the CS, neuronavigation was used to perform frameless stereotactic fine-needle biopsy sampling through the foramen ovale. The biopsy site was confirmed on postoperative computerized tomography scanning. The frameless technique was accurate in displaying a real-time trajectory of the biopsy needle throughout the procedure. The lesions within the CS were approached precisely and safely. Diagnostic tissue was obtained in all cases and treatment was administered with the aid of stereotactic radiosurgery or fractionated stereotactic radiotherapy. The patients were discharged after an overnight stay with no complications. Neuronavigation is a precise and useful tool for image-guided biopsy sampling of CS tumors via the foramen ovale.     

Application of neuronavigation system to brain tumor surgery with clinical experience of 420 cases.

A new era of neurosurgery has recently been unveiled with the advent of image-guided surgery. The use of neuronavigation is beginning to have a significant impact on a variety of intracranial procedures. Herein, we report our clinical experience using a neuronavigation system with different surgical applications and techniques for a variety of brain tumors. We used the BrainLab VectorVision neuronavigation system, which is a frameless and image-guided system. We operated on 420 cases having various types of brain tumor with the help of this system. The mean target localizing accuracy and mean volume were 1.15 mm and 30.8 mL (0.2-216.4 mL), respectively. We utilized this system to effectively make bone flaps, to detect critically located, deep-seated, subcortical, skull-base and skull bone tumors, and to operate on intraparenchymal lesions with grossly unclear margins, such as gliomas. We also performed tumor biopsy using the combination of a conventional stereotactic biopsy instrument and an endoscope. The application of the neuronavigation system not only revealed benefits for operative planning, appreciation of anatomy, lesion location and the safety of surgery, but also greatly enhanced surgical confidence.     

Supratentorial masses: stereotactic or freehand biopsy?

CT-guided stereotactic biopsy is now an accepted method of tissue sampling in intracranial mass lesions but many surgeons still practise freehand burrhole biopsy. This study compares two groups of patients who had either stereotactically guided (n = 153) or freehand (n = 217) biopsy. Stereotactic biopsy has a lower incidence of both mortality (2.6%) and morbidity (1.3%) than freehand (7.8 and 7.8%) while diagnostic accuracy is 92.1 and 64.9%, respectively. The success rate for stereotactic biopsy is independent of the size and depth of the lesion while freehand biopsy is most successful for large, superficial lesions but its success never exceeds 88%. The stereotactic technique is superior to the freehand for all intracranial biopsies regardless of size or site.     

Accuracy of stereotactic brain tumor biopsy: Comparison of the histologic findings in biopsy cylinders and resected tumor tissue

Appropriate treatment for intracranial mass lesions depends upon accurate morphological diagnosis. In 47 of 360 patients the findings in stereotactically obtained tissue cylinders were compared with tumor resection (n=38) or autopsy (n=9) tissue material to define the accuracy of our stereotactic biopsy method. These biopsies were performed using the LEKSELL CT stereotactic frame and a spiral needle which procured about 10-mm-long tissue cylinders. Usually, three to four successive biopsy specimens were taken along the target trajectory placed through the whole lesion and its margins according to the CT imagings. Final morphological diagnosis was exclusively based on the histological findings of permanent paraffin sections.In 42 cases (89%), the histological results in biopsy and resection/autopsy tissue were identical, including mainly cases of low and high grade gliomas as well as some brain lymphomas, metastases, and cases of inflammatory brain lesions (aspergillosis, toxoplasmosis). In 3 patients with a diagnosis of brain lymphoma and low grade glioma on the basis of the surgical specimens, stereotactic biopsy revealed only unspecific reactive tissue changes. In two cases of the early part of the study, sampling errors occurred. This study provides evidence for the high diagnostic accuracy of the established stereotactic biopsy method which is characterized by representative tissue sampling and histological processing of the specimens.     

Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment

Background. The authors present a retrospective analysis of 308 computed tomography (CT)-guided stereotactic biopsies in 300 patients in order to evaluate the reliability and efficacy of the stereotactic biopsy for intracranial lesions. Method. All patients were suffering from undetermined intracranial lesions and treated at Seoul National University Hospital between January 1993 and December 1999. Age ranged from three to 79 years (mean 41); the male to female ratio was 180:120. All patients underwent CT-guided stereotactic biopsy for the histological verification and/or evacuation of the cyst using Riechert-Mundinger stereotactic system®. Findings. Histological diagnosis was made in 275 patients (diagnostic yield 91.7%). Diagnostic yield was better in group with frozen section examination during the stereotactic procedure than the group without it (p=0.01). Neoplastic lesions were more likely to be diagnosed in stereotactic biospy than non-neoplastic lesions (p=0.02). Among 30 patients who underwent craniotomy after the stereotactic biopsy, the histological diagnoses after the craniotomy were identical to those of the stereotactic biospy in 29 patients (diagnostic accuracy 96.7%). Two patients died within seven days after the stereotactic biopsy (mortality 0.6%). The postoperative new neurological deficit or aggravation of the neurological status was found in 19 patients, including transient cases of seven patients (permanent morbidity rate 3.9%). Histologically malignant gliomas and deeply-located lesions were the significant risk factors for the development of complications. In 148 cases, histological diagnosis of the stereotactic biopsy was different from the preoperative clinical diagnosis. Among these cases, the treatment plan was changed after stereotactic biopsy in 81 cases. Conclusions. Stereotactic biopsy for intracranial lesions is a reliable and relatively safe procedure. It is also a very efficacious method especially in patients who need histological confirmation for the treatment.Published online July 25, 2003