Linskey Mark E
Department of Neurological Surgery, University of California, Irvine, UCI Medical Centre, Orange, CA 92868-3298, USA.
J Neurooncol. 2004 Aug-Sep;69(1-3):35-54. doi: 10.1023/b:neon.0000041870.31126.2f.
Evaluate evolution and time course of stereotactic neurosurgery within surgical neuro-oncology.
MEDLINE search 1966-2003 sub-stratified and analyzed for annual trends. AANS/CNS membership databases for Joint Sections. ACRC neuro-oncology program database 1998-2003.
Tumor stereotaxis emerged in 1980 and became the dominant stereotactic publication topic by 1984. Frame-based tumor stereotaxis led publications through 1994, when supplanted by stereotactic radiosurgery (SR). Brachytherapy led SR 1982-1987, but then fell behind, reducing to pre-1983 levels by 1996. SR publications currently comprise 65% of stereotactic tumor articles and publication rate continues to rise at a steady rate. Frameless stereotaxis (FS) publications began to increase in 1993 and growth is larger than the corresponding fall in frame-based volumetric resection publications. Data suggest increased utilization for cases that would have otherwise utilized ultrasound or gone without image guidance. Intraoperative MR developed predominantly as complimentary technology to FS. Tumor diagnostic needle biopsy publications continue to be mostly frame-based, while FS techniques are largely resection focused. This may change as >80% of our tumors biopsied with frame-based techniques would be candidates for FS biopsy based solely on lesion size, location, and technique accuracy considerations. CNS parenchymal delivery of experimental therapies continues to be predominantly frame-based.
The role of tumor stereotaxis in surgical neuro-oncology is important, but changing. SR is increasingly dominating the subspecialty. Stereotactic tumor resection has become a mainstream neurosurgical procedure due to FS, and this will likely occur with needle biopsy as well. Delivery of experimental therapies remains predominantly frame-based, but may need to transition to FS in order to gain wider mainstream acceptance and applicability once efficacy is demonstrated.
评估立体定向神经外科手术在神经肿瘤外科中的发展及时间进程。
检索1966年至2003年的MEDLINE数据库，按年份分层并分析趋势。美国神经外科医师协会/美国神经外科协会联合分会会员数据库。1998年至2003年美国放射肿瘤学会神经肿瘤项目数据库。
肿瘤立体定向技术于1980年出现，到1984年成为主要的立体定向出版主题。基于框架的肿瘤立体定向技术在1994年之前主导着出版物，之后被立体定向放射外科（SR）所取代。近距离放射治疗在1982年至1987年领先于SR，但随后落后，到1996年降至1983年以前的水平。目前，SR出版物占立体定向肿瘤文章的65%，且发表率持续稳步上升。无框架立体定向（FS）出版物于1993年开始增加，其增长幅度大于基于框架的体积切除术出版物相应的下降幅度。数据表明，对于原本会使用超声或无图像引导的病例，FS的应用有所增加。术中磁共振成像主要作为FS的辅助技术发展起来。肿瘤诊断性针吸活检出版物大多仍基于框架，而FS技术主要集中在切除方面。随着仅基于病变大小、位置和技术准确性考虑，我们用基于框架技术活检的肿瘤中超过80%将适合FS活检，这种情况可能会改变。中枢神经系统实质内实验性治疗的递送仍主要基于框架，但一旦证明其有效性，可能需要过渡到FS以获得更广泛的主流认可和适用性。
肿瘤立体定向技术在神经肿瘤外科中的作用很重要，但正在发生变化。SR在该亚专业中越来越占主导地位。由于FS，立体定向肿瘤切除术已成为主流神经外科手术，针吸活检可能也会如此。实验性治疗的递送仍主要基于框架，但一旦证明其疗效，可能需要过渡到FS，以便获得更广泛的主流接受度和适用性。
