Tanei Takafumi, Nakahara Norimoto, Takebayashi Shigenori, Hirano Masaki, Nagatani Tetsuya, Nishihata Tomoki, Wakabayashi Toshihiko
Department of Neurosurgery, Nagoya Central Hospital, Aichi, Japan.
Neurol Med Chir (Tokyo). 2012;52(8):617-21. doi: 10.2176/nmc.52.617.
Endoscope biopsy guided navigation for intra-parenchymal lesions is safe and effective, but determination of the entry point and trajectory of the endoscopic biopsy is less clear. We describe preoperative planning based on stereotactic methods, and achieving the plan using several techniques. The preoperative planning was based on stereotactic methods such as determining target, entry point, and trajectory. A transparent sheath was advanced under guidance of the navigation system and specimens collected under visual endoscopic monitoring. After collecting specimens, intraoperative magnetic resonance imaging was performed for confirming accurate sampling. Correct specimens were obtained in 6 cases as confirmed by intraoperative magnetic resonance imaging. The histological diagnoses were diffuse large B-cell type malignant lymphoma (n = 3), astrocytoma (n = 1), glioblastoma (n = 1), and inflammatory changes without neoplastic cells (n = 1). No postoperative intracranial hemorrhage or other operative complications occurred. Preoperative planning based on stereotactic methods and procedures guided by navigation systems can achieve endoscopic biopsy for intraparenchymal lesions safely and accurately.
用于脑实质内病变的内镜活检引导导航是安全有效的，但内镜活检的进针点和路径确定尚不够明确。我们描述了基于立体定向方法的术前规划，并使用多种技术实现该规划。术前规划基于立体定向方法，如确定靶点、进针点和路径。在导航系统引导下推进透明鞘管，并在内镜直视监测下采集标本。采集标本后，进行术中磁共振成像以确认采样准确。术中磁共振成像证实6例获得了正确标本。组织学诊断为弥漫性大B细胞型恶性淋巴瘤（n = 3）、星形细胞瘤（n = 1）、胶质母细胞瘤（n = 1）和无肿瘤细胞的炎症改变（n = 1）。未发生术后颅内出血或其他手术并发症。基于立体定向方法的术前规划和由导航系统引导的操作能够安全、准确地实现脑实质内病变的内镜活检。
