Takahashi Hideaki, Sugai Tsutomu, Uzuka Takeo, Kano Mizuho, Honma Junpei, Grinev Igor, Tanaka Ryuichi
Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata City, Niigata 951-8585, Japan.
No Shinkei Geka. 2004 Feb;32(2):135-40.
The purpose of this study was to assess the complication risk rate and diagnostic yield in a series of 211 procedures performed by a consistent method at one institute.
Two hundred and one patients underwent 211 stereotactic biopsy procedures for diagnosis of malignant brain tumor at Niigata University between 1987-2001. Indication for stereotactic biopsy is decided on the following factors: 1) the patient is elderly or unsuitable for craniotomy; 2) the tumor location is in a deep, diffusing, multiple, eloquent site; 3) cytoreductive surgery is not needed to treat the suspected pathology. The specimen was obtained from the target point of CT scan by the aspiration method under local anesthesia except for in six patients who were children or needed operation for a VP shunt under general anesthesia. The lesion was located in 114 cases of cerebral hemisphere, in 44 cases of basal ganglia, in 11 cases of cerebellum and in 11 cases of spreading site.
Histological diagnosis was obtained in 188 of 211 procedures and the diagnostic yield was 93.5%. There were 104 high grade gliomas, 16 low grade gliomas, 5 germ cell tumors, 37 malignant lymphomas, 19 metastatic tumors and 13 negative/inconclusive biopsies. Sixteen patients incurred complications (7.6%). Four patients (1.6%) suffered intratumoral hemorrhage. Emergency craniotomy was performed in three patients and stereotactic aspiration of hematoma was carried out in one patient. Furthermore, of 12 complications, 9 occurred with the patient showing symptoms of worsening neurological deficit, 2 occurred with general convulsion and 1 occurred with severe facial pain.
This study provided evidence that stereotactic biopsy was a safe and reliable tool for patients with unresectable malignant brain tumors.
本研究旨在评估在一所机构采用一致方法进行的211例手术中的并发症风险率和诊断率。
1987年至2001年间，201例患者在新潟大学接受了211例立体定向活检手术，以诊断恶性脑肿瘤。立体定向活检的指征取决于以下因素：1）患者年龄较大或不适合开颅手术；2）肿瘤位于深部、弥漫性、多发性、功能区；3）不需要进行减瘤手术来治疗疑似病变。除6例儿童患者或需要在全身麻醉下进行脑室腹腔分流术的患者外，其余患者均在局部麻醉下通过穿刺法从CT扫描的靶点获取标本。病变位于大脑半球114例、基底节44例、小脑11例和弥漫性部位11例。
211例手术中有188例获得了组织学诊断，诊断率为93.5%。其中高级别胶质瘤104例、低级别胶质瘤16例、生殖细胞瘤5例、恶性淋巴瘤37例、转移瘤19例，13例活检结果为阴性/不确定。16例患者出现并发症（7.6%）。4例患者（1.6%）发生瘤内出血。3例患者进行了急诊开颅手术，1例患者进行了立体定向血肿抽吸。此外，在12例并发症中，9例发生在患者神经功能缺损症状恶化时，2例发生在全身抽搐时，1例发生在严重面部疼痛时。
本研究提供了证据，表明立体定向活检对于无法切除的恶性脑肿瘤患者是一种安全可靠的工具。
