Department of Neurosurgery, Zentralklinik, Bad Berka, Germany.
Institute of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany.
World Neurosurg. 2014 Jul-Aug;82(1-2):202-6. doi: 10.1016/j.wneu.2013.01.019. Epub 2013 Jan 8.
Intraoperative ultrasound displays dynamic processes intraoperatively. Performing burr-hole biopsies under a real-time visual control is an interesting option for the neurosurgeon. However, the percentage of conclusive diagnoses obtained by this technique and the rate of complications must be evaluated in a larger series.
One hundred consecutive intracranial biopsies were analyzed. Through a burr hole, the lesion was localized by ultrasonography, and the planned needle trajectory was superimposed onto the image. Intracranial vessels were imaged by Doppler flow signals. Biopsies were taken in a mean depth of 41 mm (maximal 65 mm) from different parts of each tumor.
Thirty-six lesions involved the corpus callosum, 16 lesions were located deeply within the white matter, five in the internal capsule, and one in the upper brainstem. There were three cerebellar and 17 temporal lesions. Ten tumors did not exceed a diameter of 15 mm in any plane. The mean time interval from skin incision to the end of suturing was 45 minutes, and the mean time from the surgeons entering the operating theater to leaving the theater was 63 minutes. In 95% of the lesions, a diagnosis could be established. Transient neurologic deficits occurred in five patients, which were permanent in three. In 42 patients without postoperative neurological symptoms, postoperative computed tomography scans were obtained within 24 hours; a visible hemorrhage occurred in eight (19%), six of which were seen intraoperatively.
When intraoperative ultrasound-navigated biopsies were used they obtained a similar percentage of conclusive diagnoses as stereotactic biopsies. The complication rate is comparable as well. Emerging intracranial complications such as hemorrhages can be observed. However, their incidence cannot be decreased.
术中超声可实时显示动态过程。神经外科医师可选择在实时可视控制下进行颅骨钻孔活检。然而，必须在更大的系列中评估该技术获得的明确诊断率和并发症发生率。
分析了 100 例连续的颅内活检。通过颅骨钻孔，超声定位病变，将计划的针轨迹叠加到图像上。通过多普勒血流信号对颅内血管成像。在每个肿瘤的不同部位以平均深度 41mm（最大 65mm）进行活检。
36 个病灶累及胼胝体，16 个病灶位于白质深部，5 个位于内囊，1 个位于上脑干。有 3 个小脑病灶和 17 个颞叶病灶。10 个肿瘤在任何平面上均不超过 15mm。从皮肤切口到缝合结束的平均时间间隔为 45 分钟，外科医生进入手术室到离开手术室的平均时间为 63 分钟。95%的病灶可明确诊断。5 例患者出现短暂性神经功能缺损，其中 3 例为永久性缺损。在 42 例无术后神经症状的患者中，术后 24 小时内获得了术后 CT 扫描；8 例（19%）可见可见性出血，其中 6 例在术中可见。
当使用术中超声导航活检时，其获得的明确诊断率与立体定向活检相似。并发症发生率也相当。可以观察到新出现的颅内并发症，如出血。然而，其发生率不能降低。
