颅内特殊部位病变的立体定向活检术

目的 探讨颅内特殊部位病变立体定向活检的手术技巧及影响因素.方法 总结1994年12月～2005年12月间对颅内特殊部位病变行MR导向立体定向活检的106例病例.患者年龄6～76岁,平均42.5岁,其中男62例,女44例,病灶位于鞍区13例,基底节区35例,松果体区51例,脑干7例.使用1.0T MR机定位和Leksell-G型定向仪,ASA-602立体定向手术计划系统行定位影像三维重建并选择最佳靶点、入颅点和活检轨迹.所有靶点均使用Sedan活检针活检,活检组织标本行术中快速冰冻病检,术后行常规病理检查,必要时行免疫组化检查.结果 本组106例,获得明确病理诊断103例,其中生殖细胞瘤37例,松果体母细胞瘤5例,淋巴瘤11例,转移瘤14例,感染性病灶7例,胶质瘤26例,脑变性疾病3例;阴性(轻度胶质增生)3例.病理诊断阳性率97.17%.活检后少量出血2例,全组病例无死亡.结论 立体定向活检术是一种安全、定位精确、高诊断率的脑部疑难病变定性诊断方法,对颅内特殊部位病变的病理学诊断具有重要价值.

Stereotactic Biopsy of Intracranial Lesions in Particular Regions

Objective To explore the technical notes of stereotactic biopsy of the lesions in the intracranial particular regions and the factors influencing it. Methods MRI-guided stereotactic biopsy was performed from December 1994 to December 2005 in 106 patients with intracranial lesions in the particular regions. The patients were aged between 6 and 76 (mean 42.5) years. There were 62 males and 44 females. The lesions were located in the sellar area in 13 patients, in the basal ganglion in 35, in the pineal region in 51, and in the brain stem in 7. The 3D-image reconstructions were obtained by Leksell-G system, 1.0-Tesla magnetic resonance system (Siemens), and ASA-602 stereotactic surgical plan system for choosing the optimal target, the trajectory and the entry point. We performed biopsies for each target by using a Sedan side-cutting needle. The intraoperative frozen section and routine histopathological examination of the specimens were made. The immunohistochemical staining of the histopathological section of the specimens was performed if necessary. Results Of 106 cases of intracranial lesions, 103 were pathologically diagnosed and 3 not. The intracranial lesions were germinomas in 37 patients, pinealoblastomas in 5, lymphomas in 11, metastases in 14, inflammatory lesions in 7, gliomas in 26, and cerebral degeneration in 3. The positive rate of the pathological diagnosis was 97.17%. There was asymptomatic cerebral hemorrhage in 2 patients after the biopsy. No patient died from the stereotactic biopsy. Conclusions The stereotactic biopsy is an accurate, safe and good method to diagnose the questionable intracranial lesions and it is of great value to the pathological diagnosis of intracranial lesions in particular regions.