Bootz F, Keiner S, Schulz T, Scheffler B, Seifert V
Department of Otorhinolaryngology, University of Leipzig, Germany.
Otol Neurotol. 2001 May;22(3):383-8. doi: 10.1097/00129492-200105000-00019.
To analyze the advantages in safety and precision of biopsies of the petrous apex and petroclival region using open magnetic resonance imaging (MRI).
The University of Leipzig Medical Center.
Biopsies were taken in 13 patients with tumors of the petrous apex and petroclival region.
With the patient in the 0.5-T intraoperative MRI system (Signa SP; General Electric Medical Systems, Boston, MA, U.S.A.), biopsies were taken from the petrous apex and the petroclival region under imaging control by transseptal, transsphenoidal access. The region of interest was approached with a virtual pointer (Flashpoint Position Encoder; Image Guided Technologies, U.S.A.) and marked with a gadolinium-filled pointer.
In all patients, the authors obtained enough tissue for histologic study, which also proved to be the suspected tumor. One patient had a bone cyst, another had a malignant lymphoma, and another two a cholesterol granuloma originating from the petrous apex. Three other patients had metastases (carcinoma of the breast, bronchial carcinoma, and unknown origin). Three patients had a meningioma, and another three a chordoma. The authors did not see any postoperative complications.
In the authors' experience, the transsphenoidal access is favorable for approaching and sampling lesions of the petrous apex and the petroclival region. This route, however, is disadvantageous because the course of the internal carotid artery and the brainstem narrow the surgical space to the petrous apex. Open MRI in these cases is very useful because it allows a safe approach to the tumor by navigation and by visualizing the anatomic structures in real-time imaging.
分析使用开放式磁共振成像（MRI）对岩尖和岩斜区进行活检在安全性和精确性方面的优势。
莱比锡大学医学中心。
对13例岩尖和岩斜区肿瘤患者进行了活检。
患者处于0.5-T术中MRI系统（Signa SP；美国通用电气医疗系统公司，波士顿，马萨诸塞州）中，通过经鼻中隔、经蝶窦入路在成像引导下从岩尖和岩斜区获取活检组织。使用虚拟指针（Flashpoint位置编码器；美国图像引导技术公司）接近感兴趣区域，并用装有钆的指针进行标记。
所有患者均获取了足够的组织用于组织学研究，且证实为疑似肿瘤。1例患者为骨囊肿，1例为恶性淋巴瘤，另外2例为起源于岩尖的胆固醇肉芽肿。其他3例患者有转移瘤（乳腺癌、支气管癌和来源不明）。3例患者患有脑膜瘤，另外3例患有脊索瘤。作者未观察到任何术后并发症。
根据作者的经验，经蝶窦入路有利于接近岩尖和岩斜区的病变并进行取样。然而，该入路存在不利之处，因为颈内动脉和脑干的走行使到达岩尖的手术空间变窄。在这些情况下，开放式MRI非常有用，因为它通过导航和实时成像显示解剖结构，从而能够安全地接近肿瘤。
