Wild A M, Xuereb J H, Marks P V, Gleave J R
Department of Neurological Surgery, Addenbrooke's Hospital, University of Cambridge, UK.
Br J Neurosurg. 1990;4(5):407-15. doi: 10.3109/02688699008992763.
Two hundred consecutive stereotactic procedures were performed. These were 153 biopsies and 43 therapeutic procedures. The latter included aspiration of craniopharyngiomata, arachnoid cysts, deep-seated abscesses, and the destruction of colloid cysts. Cryogenesis was used to treat an arteriovenious malformation (AVM) in one case. In four cases, the system was used to locate lesions during open surgery. Leksell stereotactic systems were used throughout. The ages of the patients ranged between 12 months and 83 years. Overall, in 35% of biopsies the preoperative diagnosis was not confirmed. When the provisional diagnosis was glioma 70% were confirmed; 21% of them were benign, with 9% some other form of malignancy. Biopsy provided tissue on which a histological diagnosis could be made in 140 procedures. In eight cases the biopsy was repeated and in seven cases a positive diagnosis was subsequently made. Mortality was 1%; there was transient deterioration postoperatively in 5% and prolonged deterioration in 1%. These observations suggest that stereotactic surgery is far superior to freehand burr hole biopsy in the management of these lesions. No radiation treatment should be considered without histological confirmation.
共进行了200例连续的立体定向手术。其中153例为活检，43例为治疗性手术。后者包括颅咽管瘤、蛛网膜囊肿、深部脓肿的抽吸，以及胶体囊肿的破坏。1例采用冷冻疗法治疗动静脉畸形（AVM）。4例在开颅手术中使用该系统定位病变。全程使用Leksell立体定向系统。患者年龄在12个月至83岁之间。总体而言，35%的活检术前诊断未得到证实。当初步诊断为胶质瘤时，70%得到证实；其中21%为良性，9%为其他形式的恶性肿瘤。活检在140例手术中提供了可进行组织学诊断的组织。8例重复活检，7例随后得到阳性诊断。死亡率为1%；术后5%出现短暂恶化，1%出现长期恶化。这些观察结果表明，在这些病变的处理中，立体定向手术远优于徒手钻孔活检。未经组织学证实，不应考虑放疗。
