Hall W A, Martin A J, Liu H, Nussbaum E S, Maxwell R E, Truwit C L
Department of Neurosurgery, University of Minnesota School of Medicine, Minneapolis, USA.
Neurosurgery. 1999 Apr;44(4):807-13; discussion 813-4. doi: 10.1097/00006123-199904000-00067.
Lesions within the brain are commonly sampled using stereotactic techniques. The advent of interventional magnetic resonance imaging (MRI) now allows neurosurgeons to interactively investigate specific regions, with exquisite observational detail. We evaluated the safety and efficacy of this new surgical approach.
Between January 1997 and June 1998, 35 brain biopsies were performed in a high-field strength interventional MRI unit. All biopsies were performed using MRI-compatible instrumentation. Interactive scanning was used to confirm accurate positioning of the biopsy needle within the region of interest. Intraoperative pathological examination of the biopsy specimens was performed to verify the presence of diagnostic tissue, and intra- and postoperative imaging was performed to exclude the presence of intraoperative hemorrhage. Recently, magnetic resonance spectroscopic targeting was used for six patients.
Diagnostic tissue was obtained in all 35 brain biopsies and was used in therapeutic decision-making. Histological diagnoses included 28 primary brain tumors (12 glioblastomas multiforme, 9 oligodendrogliomas, 2 anaplastic astrocytomas, 2 astrocytomas, 1 lymphoma, and 1 anaplastic oligodendroglioma), 1 melanoma brain metastasis, 1 cavernous sinus meningioma, 1 cerebral infarction, 1 demyelinating process, and 3 cases of radiation necrosis. In all cases, magnetic resonance spectroscopy was accurate in distinguishing recurrent tumors (five cases) from radiation necrosis (one case). No patient sustained clinically or radiologically significant hemorrhage, as determined by intraoperative imaging performed immediately after the biopsy. One patient (3%) suffered transient hemiparesis after a pontine biopsy for investigation of a brain stem glioma. Another patient developed scalp cellulitis, with possible intracranial extension, 3 weeks after the biopsy; this condition was effectively treated with antibiotic therapy. Three patients were discharged on the day of the biopsy.
Interventional 1.5-T MRI is a safe and effective method for evaluating lesions of the brain. Magnetic resonance spectroscopic targeting is likely to augment the diagnostic yield of brain biopsies.
脑内病变通常采用立体定向技术进行采样。介入性磁共振成像（MRI）的出现，使神经外科医生能够以精细的观察细节交互式地研究特定区域。我们评估了这种新手术方法的安全性和有效性。
1997年1月至1998年6月期间，在一个高场强介入性MRI设备中进行了35例脑活检。所有活检均使用与MRI兼容的器械。采用交互式扫描确认活检针在感兴趣区域内的准确定位。对活检标本进行术中病理检查以验证诊断性组织的存在，并进行术中和术后成像以排除术中出血。最近，对6例患者使用了磁共振波谱靶向技术。
所有35例脑活检均获取了诊断性组织，并用于治疗决策。组织学诊断包括28例原发性脑肿瘤（12例多形性胶质母细胞瘤、9例少突胶质细胞瘤、2例间变性星形细胞瘤、2例星形细胞瘤、1例淋巴瘤和1例间变性少突胶质细胞瘤）、1例黑色素瘤脑转移、1例海绵窦脑膜瘤、1例脑梗死、1例脱髓鞘病变和3例放射性坏死。在所有病例中，磁共振波谱在区分复发性肿瘤（5例）和放射性坏死（1例）方面是准确的。根据活检后立即进行的术中成像，没有患者出现临床或放射学上显著的出血。1例患者（3%）在进行脑桥活检以检查脑干胶质瘤后出现短暂性偏瘫。另1例患者在活检后3周出现头皮蜂窝织炎，可能有颅内蔓延；经抗生素治疗后病情得到有效控制。3例患者在活检当天出院。
介入性1.5-T MRI是评估脑病变的一种安全有效的方法。磁共振波谱靶向技术可能会提高脑活检的诊断率。
