影像学引导的立体定向活检在脑疾病诊断中的价值 (附50例临床分析)

目的探讨影像学引导的立体定向活检手术在神经科临床表现及影像学检查不典型病例诊断中的应用价值。方法安装CRW立体定向框架,采用螺旋CT薄层扫描与多层图像三维重建技术,对50例临床表现及影像学检查不典型的患者施行立体定向脑组织活检手术,其中:额叶深部病灶7例,颞叶7例,顶枕叶8例,鞍区4例,丘脑和基底节区9例,第三脑室后部3例,小脑半球4例,颅内多发性病灶(病灶2~7个不等)8例。结果50例患者均得到明确的病理诊断及相应的治疗,病理诊断结果:星形细胞瘤12例(其中I级4例,I~Ⅱ级2例,Ⅱ级2例,Ⅱ~Ⅲ级2例,Ⅲ级2例),胶质母细胞瘤3例,脑胶质瘤病1例,室管膜瘤1例,生殖细胞瘤l例,松果体母细胞瘤2例,恶性淋巴瘤2例,脑白质营养不良1例,线粒体脑病1例,脑囊虫病2例,脱髓鞘改变(白质多发性硬化)5例,炎性肉芽肿10例,脑变性疾病4例,转移瘤5例。诊断成功率达100%,未出现因活检手术而造成的出血、偏瘫等严重并发症。结论影像学引导的立体定向活检手术对于神经科临床表现及影像学检查不典型病例,快速获得明确的病理学诊断,制定相应的治疗方案,是一种安全、可靠的手段,对脑疾病的诊断治疗具有重要的应用价值。

Application of stereotactic biopsy for diagnosis of atypical neural diseases

Objective To explore the role of imaging guided stereotactic biopsy for diagnosis of atypical neural diseases.Methods Using thin thickness of spiral CT scan and three dimensional reconstruction-guided stereotactic brain biopsies were performed with CRW stereotactical frame in fifty patients whose clinical manifestion were atypical or the brain lesions were unable to be detected by neural imaging examination.The leisions of biopsy were located in deep frontal lobe in 7,temporal in 7,parietal and occipital lobe in 8,sella turcica region in 4,thalamus and basal ganglia region in 9,posterior region of third ventricle in 3,cerebellum in 4 and multiple in 8 cases.Results Definite pathologic diagnosis and appropriate treatment were given to all these patients.The result of the pathological diagnosis was astrocytoma in 12,glioblastoma in 3,neurospongioma in 1,ependynoma in 1,germinoma in 1,pinealoblastoma in 2,malignant lymphoma in 2,leukodystrophy in 1,mitochondrial encephalopathy in 1,brain cysticercosis in 2,demyelination in 5,inflammtory granuloma in 10,cerebral degeneration in 4 and brain metastases in 5 cases.No serious complication(intracranial hematoma,paralysis)caused by brain biopsy occuued in all fifty patients.The lesions included astrocytoma,demyelination,brain cysticercosis et a1.Conclusion Imaging-guided stereotactic brain biopsy can provide a rapid and reliable pathological diagnosis and effective treatment especially for the cases whose clinical manifestion were atypical and the pathological diagnosis of brain lesions were unable to be implied and detected by neural imaging examination.