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。

MRI/CT-guided stereotactic biopsy for intracranial lesions

Objective To investigate the histological diagnostic efficacy and accuracy of stereotactic biopsy for brain lesions under computer tomography (CT) and magnetic resonance imaging (MRI) guidance,meanwhile, explore the operation techniques of brain biopsy. Methods CT/MRI-guided stereotactic biopsies were performed in 605 cases with intracranial lesions. All the procedures were done under local anesthesia with Leksell stereotactic system. The CT or MRI film was used to determine the coordinate in 450 cases and the Computer-assisted Planning for Neurosurgery (CAPN) in 155 cases. Results Brain tumors were diagnosed pathologically in 522 cases, inflammatory disease in 39, Parasitic disease or cystic lesions in 23 and 16 were nondiagnostic. The total positive rate of biopsy was 97.36%. Complications associated with biopsy occurred in 15 patients, and 2 died following the procedure. Conclusions The result suggests that the stereotactic biopsy using an MRI-guided stereotactic approach or a CT-guided technique represents a safe and reliable method for histological diagnosis of many intracranial deep lesions.