Yamada Kazumichi, Goto Satoshi, Kochi Masato, Ushio Yukitaka
Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan.
J Clin Neurosci. 2004 Apr;11(3):263-7. doi: 10.1016/j.jocn.2003.03.004.
Using the Leksell stereotactic system, we selectively performed 91 biopsies for surgically inaccessible brain lesions. There were 25 multiple (27.5%), 15 diffuse (16.5%), and 51 (56.0%) deep-seated lesions. However, we avoided subjecting the patients with lesions adjacent to major vascular trunks or complex vascular structures such as the cavernous sinus, peri-insular regions and the pineal regions to stereotactic biopsy. The diagnosis was histologically confirmed in 84 cases (92.3%). Sixty-nine (75.8%) lesions were primary tumors; 44 (48.4%) were malignant gliomas, 18 (19.8%) malignant lymphomas, and five (5.5%) low-grade gliomas. Thirteen (14.3%) cases had previously undergone radiation and/or chemotherapy for brain tumors, seven had recurrent glioma (five with malignant transformation) and six manifested radiation necrosis. None of the patients died due to the stereotactic procedure; one (1.1%) exhibited morbidity due to complicated hemorrhage. We found asymptomatic minor bleeding occurred in nine (9.9%) patients; the rate of hemorrhage was significantly higher in patients with preoperative angiographic evidence of tumor stain. Two patients (2.2%) suffered seizures, in one case seizure was induced by electric stimulation test at the target site. All five patients younger than 15 years underwent the procedure without complications. The Leksell stereotactic system is useful for diagnostic tissue sampling and contributes effectively to the selection of appropriate therapy in patients with malignant brain tumors. While it carries a low morbidity rate without mortality in our series, care must be taken for selected target sites in highly vascularized lesions exhibiting positive tumor stains.
我们使用Leksell立体定向系统，对91例手术难以触及的脑病变进行了选择性活检。其中有25例为多发性病变（27.5%），15例为弥漫性病变（16.5%），51例为深部病变（56.0%）。然而，我们避免对病变邻近主要血管干或复杂血管结构（如海绵窦、岛周区域和松果体区域）的患者进行立体定向活检。84例（92.3%）的诊断经组织学证实。69例（75.8%）病变为原发性肿瘤；44例（48.4%）为恶性胶质瘤，18例（19.8%）为恶性淋巴瘤，5例（5.5%）为低级别胶质瘤。13例（14.3%）患者此前曾接受过脑肿瘤放疗和/或化疗，7例为复发性胶质瘤（5例发生恶性转化），6例表现为放射性坏死。无一例患者因立体定向手术死亡；1例（1.1%）因并发出血出现并发症。我们发现9例（9.9%）患者出现无症状轻微出血；术前血管造影有肿瘤染色证据的患者出血率明显更高。2例（2.2%）患者发生癫痫，1例癫痫由靶点部位电刺激试验诱发。所有5例15岁以下患者手术均无并发症。Leksell立体定向系统对于诊断性组织取样很有用，能有效帮助选择恶性脑肿瘤患者的合适治疗方法。虽然在我们的系列研究中其并发症发生率低且无死亡病例，但对于血管高度丰富且有肿瘤染色阳性的病变，选择靶点时必须谨慎。
