Buchalla Rüdiger, Hopf-Jensen Silke, Rubarth Ortwin, Börm Wolfgang
DIAKO Flensburg, Neurochirurgische Klinik, Flensburg, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2013 Sep;74(5):321-4. doi: 10.1055/s-0032-1315790. Epub 2012 Jul 7.
Implementation of a new neuronavigation system in the department included the opportunity to change the brain biopsy procedures from a frame-based system to a frameless system--the BrainLAB® VarioGuide. We report our first 20 consecutive procedures within 2 years, analyzing the effectiveness of this new tool.
PATIENTS, MATERIALS, AND METHODS: 15 men and 5 women with various intracerebral lesions were biopsied. Their average age was 62 years (range, 41-83 years). Preoperative planning was performed using computed tomography (CT) or magnetic resonance imaging (MRI) data provided by a radiological picture archiving and communication system (PACS) sent to the planning station. Planning was based on either MRI or CT in 14 and 4 cases, respectively, and a combination of both in 2 cases.
The lesions had a mean maximal diameter of 42.97 mm (range, 5.8-109.8 mm). 19 lesions were supratentorial, 1 of those intraventricular, and 1 lesion was infratentorial, within the cerebellar peduncle and brainstem. During surgery, the samples were sent to neuropathological examination, and the procedure was completed after confirmation that pathological tissue was obtained. In 18 of 20 cases, definitive pathological tissue was harvested. Histopathology confirmed 8 glioblastomas, 1 oligoastrocytoma, 4 anaplastic astrocytomas, 1 astrocytoma, and 2 primary central nervous system lymphomas, as well as 1 encephalitis and 1 necrotic tissue of unknown origin. In 3 cases, including the case of necrotic tissue, there was no final diagnosis possible. Referencing the BrainLAB® navigation system and software-wizard guided sterile adjustment of the VarioGuide arm over the entry point took 5 to 10 minutes. The mean operation time was 49 minutes (range, 24-69 minutes) including the time until first neuropathological examination was completed. No adverse events occurred during or after the operation.
在科室中实施一种新的神经导航系统，这带来了将脑活检程序从基于框架的系统转变为无框架系统——BrainLAB® VarioGuide的机会。我们报告了2年内连续进行的前20例手术，分析了这种新工具的有效性。
患者、材料与方法：对15名男性和5名女性患有各种脑内病变的患者进行了活检。他们的平均年龄为62岁（范围41 - 83岁）。术前规划使用由放射图像存档与通信系统（PACS）提供的计算机断层扫描（CT）或磁共振成像（MRI）数据发送至规划站。分别有14例和4例规划基于MRI或CT，2例基于两者结合。
病变的平均最大直径为42.97毫米（范围5.8 - 109.8毫米）。19个病变位于幕上，其中1个位于脑室内，1个病变位于幕下，在小脑脚和脑干内。手术过程中，样本被送去进行神经病理学检查，在确认获得病理组织后手术完成。20例中有18例获取到了明确的病理组织。组织病理学确诊8例胶质母细胞瘤、1例少突星形细胞瘤、4例间变性星形细胞瘤、1例星形细胞瘤、2例原发性中枢神经系统淋巴瘤，以及1例脑炎和1例不明来源的坏死组织。在3例中，包括坏死组织的病例，无法做出最终诊断。参考BrainLAB®导航系统并通过软件向导在入口点上方引导VarioGuide臂进行无菌调整耗时5至10分钟。平均手术时间为49分钟（范围24 - 69分钟），包括直至首次神经病理学检查完成的时间。手术期间及术后未发生不良事件。
