Air Ellen L, Leach James L, Warnick Ronald E, McPherson Christopher M
Department of Neurosurgery, Brain Tumor Center at The University of Cincinnati Neuroscience Institute and University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0515, USA.
J Neurosurg. 2009 Oct;111(4):820-4. doi: 10.3171/2009.3.JNS081695.
Frameless stereotactic biopsy has been shown in multiple studies to be a safe and effective tool for the diagnosis of brain lesions. However, no study has directly evaluated its safety in lesions located in eloquent regions in comparison with noneloquent locations. In this study, the authors determine whether an increased risk of neurological decline is associated with biopsy of lesions in eloquent regions of the brain.
Medical records, including imaging studies, were reviewed for 284 cases in which frameless stereotactic biopsy procedures were performed by 19 neurosurgeons at 7 institutions between January 2000 and December 2006. Lesion location was classified as eloquent or noneloquent in each patient. The incidence of neurological decline was calculated for each group.
During the study period, 160 of the 284 biopsies predominately involved eloquent regions of the brain. In evaluation of the complication rate with respect to biopsy site, neurological decline occurred in 9 (5.6%) of 160 biopsies in eloquent brain areas and 10 (8.1%) of 124 biopsies in noneloquent regions; this difference was not statistically significant (p = 0.416). A higher number of needle passes was associated with the presence of a postoperative hemorrhage at the biopsy site, although not with a change in the result of neurological examination.
Frameless stereotactic biopsy of lesions located in eloquent brain regions is as safe and effective as biopsy of lesions in noneloquent regions. Therefore, with careful planning, frameless stereotactic biopsy remains a valuable and safe tool for diagnosis of brain lesions, independent of lesion location.
多项研究表明，无框架立体定向活检是诊断脑病变的一种安全有效的工具。然而，尚无研究直接评估其在明确功能区病变与非明确功能区病变中的安全性。在本研究中，作者确定脑明确功能区病变活检是否与神经功能衰退风险增加相关。
回顾了2000年1月至2006年12月期间7家机构的19位神经外科医生进行的284例无框架立体定向活检手术的病历，包括影像学研究。对每位患者的病变位置进行明确功能区或非明确功能区分类。计算每组神经功能衰退的发生率。
在研究期间，284例活检中有160例主要涉及脑明确功能区。在评估活检部位的并发症发生率时，脑明确功能区的160例活检中有9例（5.6%）出现神经功能衰退，非明确功能区的124例活检中有10例（8.1%）出现神经功能衰退；这种差异无统计学意义（p = 0.416）。穿刺次数较多与活检部位术后出血有关，尽管与神经功能检查结果的变化无关。
脑明确功能区病变的无框架立体定向活检与非明确功能区病变的活检一样安全有效。因此，经过精心规划，无框架立体定向活检仍然是诊断脑病变的一种有价值且安全的工具，与病变位置无关。
