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.

Clinical experience of stereotactic biopsy for the brain lesions

Objectives To investigate the methodology of diversified advanced image-guided stereotactic biopsy for the brain lesions, and its diagnostic significance and experience in nervous system diseases. Methods Retrospectively reviewed 1187 cases of brain lesions underwent image-guided stereotactic biopsy from December 1987 to January 2009. There were 694 male (58.5% )and 493 female (41.5%)patients, aged from 1 to 85 years (average 39.7 years). There were 607 cases in CT-guided,including positron emission computed tomography (PET)guided stereotactic biopsy; 580 cases in MRI-guided, including proton magnetic resonance spetroscopy (1H-MRS)guided stereotactic biopsy. Routine frame was used in 726 cases and frameless stereotactic biopsy in 461 cases, including neuroendoscopic biopsy in 28 cases, guided by computer assisted surgery (CAS)computer-assistant robot. In the early 450 cases,CT/MRI images films were employed to measure the coordinates of the target by hand, while in the late 737 cases, computer-assistant planning software rebuilded the CT/MRI images and figured out the optimal neurosurgical path for biopsy. Results The positive diagnosis rate of biopsy was 97.4% , 983 (82. 8% )cases were diagnosed pathologically as brain tumors, and 173 (14. 6% )cases as non-tumor diseases. The tumors mainly including neuroglioma, metastatic tumor, primary central nervous system lymphoma and germ cell tumors. In non-tumor diseases, mainly including multiple sclerosis, tumefactive demyelinating lesion,neurodegenerative disease, inflammation and parasite. The biopsy operation caused small hematoma without neurological deficits in 20 cases(1.7%),and caused large hematoma (> 10 ml)which need neurosurgical treatment (catherization or craniotomy evacuation of hematoma)in 9 cases (0. 8% ). Hemorrhage associated with biopsy caused 3 cases(0.3% )death. There were no severe intracranial infection cases. Conclusions The stereotactic biopsy with advanced image-guided technique represents a safe, reliable and minimally invasive method for pathological diagnosis of intracranial lesions. Moreover, the developments of biochemical imaging gives a new concept to the stereotactic biopsy.