Haegelen C, Touzet G, Reyns N, Maurage C-A, Ayachi M, Blond S
Service de neurochirurgie, CHRU de Lille, rue du Professeur-Emile-Laine, 59037 Lille cedex, France.
Neurochirurgie. 2010 Oct;56(5):363-7. doi: 10.1016/j.neuchi.2010.05.006. Epub 2010 Aug 21.
Biopsies of brain stem lesions are useful for histopathological analysis, which guide appropriate treatment. The frame-based stereotactic procedure is the gold standard technique for biopsies of the brain stem. For the past few years, a frameless stereotactic robot, the NeuroMate robot (Renishaw, UK) has also been used for brain biopsies. We report a retrospective study of 15 patients who underwent NeuroMate robot-guided biopsies of brain stem lesions to evaluate the efficiency and safety of the system.
From January 2004 to March 2006, 15 patients (five children and ten adults) underwent 17 biopsies of brain stem lesions. The lesions were located in the mesencephalon in two cases, in the pons in seven cases, in the pons and the medulla oblongata in five cases, and in the whole midbrain in one case. The biopsy procedure comprised four stages: image acquisition, preoperative planning, patient-to-image registration, and operative procedure. A transcerebellar approach was used in 12 cases and a double oblique anterior frontal approach in five cases.
Two adults underwent a second procedure because the first biopsy was not contributive. There was no operative mortality. We observed two cases of transient morbidity and one case of permanent morbidity.
The frameless NeuroMate robot is an efficient and safe instrument for biopsies of brain stem lesions. We believe that the use of frameless stereotactic techniques for brain stem biopsies could increase the number of biopsies and therefore improve the diagnostic yield and accuracy of the technique.
脑干病变活检有助于组织病理学分析，从而指导恰当的治疗。基于框架的立体定向手术是脑干活检的金标准技术。在过去几年中，一种无框架立体定向机器人——NeuroMate机器人（英国雷尼绍公司）也被用于脑活检。我们报告了一项对15例行NeuroMate机器人引导下脑干病变活检患者的回顾性研究，以评估该系统的有效性和安全性。
2004年1月至2006年3月，15例患者（5名儿童和10名成人）接受了17次脑干病变活检。病变位于中脑2例，脑桥7例，脑桥和延髓5例，整个中脑1例。活检过程包括四个阶段：图像采集、术前规划、患者与图像配准以及手术操作。12例采用经小脑入路，5例采用双斜额前入路。
2名成人因首次活检无诊断价值而接受了第二次手术。无手术死亡病例。我们观察到2例短暂性并发症和1例永久性并发症。
无框架NeuroMate机器人是一种用于脑干病变活检的高效且安全的器械。我们认为，使用无框架立体定向技术进行脑干活检可增加活检数量，从而提高该技术的诊断率和准确性。
