Dellaretti Marcos, Reyns Nicolas, Touzet Gustavo, Dubois François, Gusmão Sebastião, Pereira Júlio Leonardo Barbosa, Blond Serge
Department of Neurosurgery, Hospital Roger Salengro, Lille, France.
Stereotact Funct Neurosurg. 2012;90(2):79-83. doi: 10.1159/000335502. Epub 2012 Jan 27.
An important aspect of evaluating patients submitted to stereotactic biopsy of the brainstem is the trajectory used. The literature describes two principal approaches: the suboccipital transcerebellar and the transfrontal; however, no studies exist comparing these two techniques.
The purpose of this study was to compare diagnosis success rates and complications between the suboccipital transcerebellar and transfrontal trajectories.
The study evaluated 142 patients submitted to stereotactic biopsy. The patients presented brainstem tumors in the following areas: pons (n = 31), midbrain (n = 36), medulla (n = 2), pons-medulla (n = 30), pons-midbrain (n = 33), and midbrain-pons-medulla (n = 10). On 123 patients, the transfrontal approach was used, and on 19 the suboccipital transcerebellar approach.
Comparing success rates between the two approaches, it was observed that in the group of patients submitted to the transfrontal approach, 95.1% (117 cases) were successful, while in those submitted to the suboccipital transcerebellar approach, 84.2% (16 cases) were successful. Despite a higher success rate among patients in the first group, the difference was not statistically significant. Regarding complications, in patients who were biopsied via the transfrontal trajectory, the morbidity rate was 9.8% (12 cases), while in patients submitted to the suboccipital transcerebellar approach, the morbidity rate was 5.3% (1 case) and the mortality rate 5.3% (1 case).
This study verified a higher diagnosis rate in patients submitted to the transfrontal approach than in those submitted to the suboccipital transcerebellar approach (95.1 vs. 84.2%); however, the difference was not statistically significant. Regarding complications, the rate was similar in both groups of patients.
评估接受脑干立体定向活检的患者时，所使用的手术路径是一个重要方面。文献描述了两种主要方法：枕下经小脑入路和经额入路；然而，尚无研究对这两种技术进行比较。
本研究的目的是比较枕下经小脑和经额路径的诊断成功率及并发症情况。
本研究评估了142例接受立体定向活检的患者。这些患者的脑干肿瘤位于以下区域：脑桥（n = 31）、中脑（n = 36）、延髓（n = 2）、脑桥 - 延髓（n = 30）、脑桥 - 中脑（n = 33）以及中脑 - 脑桥 - 延髓（n = 10）。123例患者采用经额入路，19例采用枕下经小脑入路。
比较两种入路的成功率，发现采用经额入路的患者组中，95.1%（117例）成功，而采用枕下经小脑入路的患者组中，84.2%（16例）成功。尽管第一组患者的成功率较高，但差异无统计学意义。关于并发症，经额路径活检的患者发病率为9.8%（12例），而采用枕下经小脑入路的患者发病率为5.3%（1例），死亡率为5.3%（1例）。
本研究证实，采用经额入路的患者诊断率高于采用枕下经小脑入路的患者（95.1%对84.2%）；然而，差异无统计学意义。关于并发症，两组患者的发生率相似。
