Dammers R, Haitsma I K, Schouten J W, Kros J M, Avezaat C J J, Vincent A J P E
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Acta Neurochir (Wien). 2008 Jan;150(1):23-9. doi: 10.1007/s00701-007-1473-x. Epub 2008 Jan 3.
Frameless stereotaxy or neuronavigation has evolved into a feasible technology to acquire intracranial biopsies with good accuracy and little mortality. However, few studies have evaluated the diagnostic yield, morbidity, and mortality of this technique as compared to the established standard of frame-based stereotactic brain biopsy. We report our experience of a large number of procedures performed with one or other technique.
We retrospectively assessed 465 consecutive biopsies done over a ten-year time span; Data from 391 biopsies (227 frame-based and 164 frameless) were available for analysis. Patient demographics, peri-operative characteristics, and histological diagnosis were reviewed and then information was analysed to identify factors associated with the biopsy not yielding a diagnosis and of it being followed by death.
On average, nine tissue samples were taken with either stereotaxy technique. Overall, the biopsy led to a diagnosis on 89.4% of occasions. No differences were found between the two biopsy procedures. In a multiple regression analysis, it was found that left-sided lesions were less likely to result in a non-diagnostic tissue sample (p = 0.023), and cerebellar lesions showed a high risk of negative histology (p = 0.006). Postoperative complications were seen after 12.1% of biopsies, including 15 symptomatic haemorrhages (3.8%). There was not a difference between the rates of complication after either a frame-based or a frameless biopsy. Overall, peri-operative complications (p = 0.030) and deep-seated lesions (p = 0.060) increased the risk of biopsy-related death. Symptomatic haemorrhages resulting in death (1.5% of all biopsies) were more frequently seen after biopsy of a fronto-temporally located lesion (p = 0.007) and in patients with a histologically confirmed lymphoma (p = 0.039).
The diagnostic yield, complication rates, and biopsy-related mortality did not differ between a frameless biopsy technique and the established frame-based technique. The site of the lesion and the occurrence of a peri-operative complication were associated with the likelihood of failure to achieve a diagnosis and with death after biopsy. We believe that using intraoperative frozen section or cytologic smear histology is essential during a stereotactic biopsy in order to increase the diagnostic yield and to limit the number of biopsy specimens that need to be taken.
无框架立体定向术或神经导航已发展成为一种可行的技术，用于获取颅内活检组织，具有较高的准确性和较低的死亡率。然而，与既定的基于框架的立体定向脑活检标准相比，很少有研究评估该技术的诊断率、发病率和死亡率。我们报告了使用这两种技术进行大量手术的经验。
我们回顾性评估了在十年时间跨度内连续进行的465例活检；可获得391例活检（227例基于框架，164例无框架）的数据用于分析。回顾患者的人口统计学、围手术期特征和组织学诊断，然后分析信息以确定与活检未得出诊断以及活检后死亡相关的因素。
平均而言，两种立体定向技术均采集了9份组织样本。总体而言，活检在89.4%的情况下得出了诊断。两种活检方法之间未发现差异。在多元回归分析中，发现左侧病变导致非诊断性组织样本的可能性较小（p = 0.023），而小脑病变显示组织学阴性的风险较高（p = 0.006）。12.1%的活检后出现术后并发症，包括15例有症状出血（3.8%）。基于框架或无框架活检后的并发症发生率没有差异。总体而言，围手术期并发症（p = 0.030）和深部病变（p = 0.060）增加了活检相关死亡的风险。导致死亡的有症状出血（占所有活检的1.5%）在额颞部病变活检后（p = 0.007）和组织学确诊为淋巴瘤的患者中（p = 0.039）更常见。
无框架活检技术与既定的基于框架的技术在诊断率、并发症发生率和活检相关死亡率方面没有差异。病变部位和围手术期并发症的发生与活检未能得出诊断的可能性以及活检后死亡相关。我们认为，在立体定向活检期间使用术中冰冻切片或细胞学涂片组织学对于提高诊断率和限制需要采集的活检标本数量至关重要。
