Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan,
Neurosurg Rev. 2013 Oct;36(4):595-600; discussion 600-1. doi: 10.1007/s10143-013-0467-9. Epub 2013 Apr 9.
Stereotactic biopsy has been validated for tissue sampling of deep-seated lesions that cannot be easily resected via open craniotomy. However, some inherent problems including the inability to directly observe the lesion and difficulty in confirming hemostasis limit its usefulness. To overcome these issues, we used the endoscope in brain tumor biopsy, for not only intraventricular tumors but also intraparenchymal tumors. The rigid scope was used in association with a surgical navigation system for intraparenchymal lesions via a transcortical route. There were no useful anatomical landmarks when the trajectory to the lesions was decided; therefore, surgical navigation system was required for the transcortical procedures. The endoscopic procedure described here was attempted in 21 cases of intraparenchymal lesions between January 2007 and February 2012. A definitive diagnosis was obtained in all cases, and genetic analysis was performed when required. Serious postsurgical hemorrhage or neurological deficits were not observed in any cases. Endoscopic surgery provides a clear view of the target and makes it easier to differentiate tumor tissue from normal brain tissue. Moreover, the endoscope helped to confirm hemostasis during the procedure. Thus, endoscopic biopsy has the potential to contribute toward safe and reliable diagnosis of brain tumors.
立体定向活检已被验证可用于深部病变的组织取样，这些病变无法通过开颅手术轻易切除。然而，一些固有的问题，包括无法直接观察病变和难以确认止血，限制了其用途。为了克服这些问题，我们在脑肿瘤活检中使用了内窥镜，不仅用于脑室肿瘤，也用于脑实质肿瘤。对于脑实质病变，我们使用刚性内窥镜并结合手术导航系统经皮质入路进行操作。当决定病变的轨迹时，没有有用的解剖学标志；因此，皮质内手术需要手术导航系统。本文描述的内镜手术于 2007 年 1 月至 2012 年 2 月期间尝试用于 21 例脑实质病变。所有病例均获得明确诊断，必要时进行了基因分析。在任何病例中均未观察到严重的术后出血或神经功能缺损。内镜手术可以提供目标的清晰视野，使肿瘤组织与正常脑组织更容易区分。此外，内窥镜有助于在手术过程中确认止血。因此，内镜活检有可能有助于脑肿瘤的安全可靠诊断。
