Quick-Weller Johanna, Tichy Julia, Dinc Nazife, Tritt Stephanie, Won Sae-Yeon, Behmanesh Bedjan, Bruder Markus, Seifert Volker, Weise Lutz M, Marquardt Gerhard
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Department of Neurooncology, Goethe-University Frankfurt, Frankfurt, Germany.
World Neurosurg. 2017 Jun;102:442-448. doi: 10.1016/j.wneu.2017.03.059. Epub 2017 Mar 23.
Stereotactic biopsy is an everyday procedure implemented in numerous neurosurgical departments. The procedure is performed to obtain tumor tissue of unclear diagnosis. Going in hand with low complication rates and high diagnostic yield, stereotactic biopsies can be performed in adults and children likewise for histopathologic evaluation of lesions in eloquent localizations. However, little is known about whether aged patients do benefit from stereotactic biopsy or rather the therapy that is derived from histopathologic results. In this study, we therefore focused on old (80-84 years) and very old patients (85 years and older) to evaluate whether stereotactic biopsy should be performed leading to further therapy. We also assessed the complication rates of the procedure in this aged population.
We performed a retrospective analysis of our database and included all patients older than 80 years who underwent stereotactic biopsy at our department from October 2005 until May 2016. Forty-seven patients were included in this study. These patients were divided into 2 subgroups: group 1 consisted of patients from 80 to 84 years old and group 2 of patients aged 85 years and older. All patients underwent stereotactic biopsy to establish histopathologic diagnosis. We excluded patients who underwent cyst puncture or puncture of a hemorrhage because the procedure was not performed for diagnostic purposes. We assessed gender, neuroradiologic diagnosis, Karnofsky Performance Score (KPS), number of tissue samples taken, histopathologic diagnosis, localization, postoperative hemorrhage, modality of anesthesia anticoagulation, and further therapy.
Group 1 consisted of 34 patients and group 2 of 13 patients. KPS was 80 and 70, respectively. A histopathologic diagnosis was possible in all but 1 patient. In group 1, 61.8% of the patients agreed to further postoperative therapy (radiation, 35.3%; chemotherapy, 11.8%; combined radiochemotherapy, 11.8%; complication that prevented therapy, 2.9%), as did 53.8% of the patients in group 2 (resection, 7.7%; radiation, 15.4%; combined radiochemotherapy, 30.7%). In group 1, 38.2% declined further therapy, as did 64.1% in group 2.
Also in old and very old patients, a final histopathologic diagnosis should be established to provide adequate therapy. Our data show that most of these aged patients want to be treated.
立体定向活检是众多神经外科科室日常开展的一项操作。该操作旨在获取诊断不明的肿瘤组织。立体定向活检并发症发生率低且诊断准确率高，在成人和儿童中均可进行，用于对功能区病变进行组织病理学评估。然而，对于老年患者是否能从立体定向活检或从组织病理学结果得出的治疗方案中获益，人们了解甚少。因此，在本研究中，我们聚焦于年龄较大（80 - 84岁）和高龄（85岁及以上）患者，以评估是否应进行立体定向活检并由此开展进一步治疗。我们还评估了该老年人群中该操作的并发症发生率。
我们对数据库进行了回顾性分析，纳入了2005年10月至2016年5月在我科接受立体定向活检的所有80岁以上患者。本研究共纳入47例患者。这些患者被分为2个亚组：第1组为80至84岁的患者，第2组为85岁及以上的患者。所有患者均接受立体定向活检以确立组织病理学诊断。我们排除了接受囊肿穿刺或出血穿刺的患者，因为这些操作并非用于诊断目的。我们评估了患者的性别、神经放射学诊断、卡氏功能状态评分（KPS）、所取组织样本数量、组织病理学诊断、病变部位、术后出血情况、麻醉方式、抗凝情况以及进一步治疗情况。
第1组有34例患者，第2组有13例患者。KPS评分分别为80分和70分。除1例患者外，所有患者均获得了组织病理学诊断。在第1组中，61.8%的患者同意接受进一步的术后治疗（放疗，35.3%；化疗，11.8%；放化疗联合，11.8%；因并发症无法治疗，2.9%），第2组中这一比例为53.8%（手术切除，7.7%；放疗，15.4%；放化疗联合，30.7%）。在第1组中，38.2%的患者拒绝进一步治疗，第2组中这一比例为64.1%。
对于年龄较大和高龄患者，也应确立最终的组织病理学诊断以提供适当治疗。我们的数据表明，这些老年患者中的大多数都希望接受治疗。
