Quick-Weller Johanna, Brawanski Nina, Dinc Nazife, Behmanesh Bedjahn, Kammerer Sara, Dubinski Daniel, Seifert Volker, Marquardt Gerhard, Weise Lutz
a Neurosurgical Clinic , Goethe-University Frankfurt , Frankfurt , Germany.
b Institute for Neuroradiology , Goethe-University Frankfurt , Frankfurt , Germany.
Br J Neurosurg. 2018 Apr;32(2):210-213. doi: 10.1080/02688697.2017.1394444. Epub 2017 Oct 26.
Biospies of brain lesions with unknown entity are an everyday procedure among many neurosurgical departments. Biopsies can be performed frame-guided or frameless. However, cerebellar lesions are a special entity with a more complex approach. All biopsies in this study were performed stereotactically frame guided. Therefore, only biopsies of cerebellar lesions were included in this study. We compared whether the frame was attached straight versus oblique and we focused on diagnostic yield and complication rate.
We evaluated 20 patients who underwent the procedure between 2009 and 2017. Median age was 56.5 years. 12 (60%) Patients showed a left sided lesion, 6 (30%) showed a lesion in the right cerebellum and 2 (10%) patients showed a midline lesion.
The stereotactic frame was mounted oblique in 12 (60%) patients and straight in 8 (40%) patients. Postoperative CT scan showed small, clinically silent blood collection in two (10%) of the patients, one (5%) patient showed haemorrhage, which caused a hydrocephalus. He received an external ventricular drain. In both patients with small haemorrhage the frame was positioned straight, while in the patient who showed a larger haemorrhage the frame was mounted oblique. In all patients a final histopathological diagnosis was established.
Cerebellar lesions of unknown entity can be accessed transcerebellar either with the stereotactic frame mounted straight or oblique. Also for cerebellar lesions the procedure shows a high diagnostic yield with a low rate of severe complications, which need further treatment.
在许多神经外科科室中，对性质不明的脑病变进行活检是日常操作。活检可在框架引导或无框架的情况下进行。然而，小脑病变是一种特殊情况，其手术方法更为复杂。本研究中的所有活检均在立体定向框架引导下进行。因此，本研究仅纳入了小脑病变的活检病例。我们比较了框架是垂直安装还是倾斜安装，并关注诊断率和并发症发生率。
我们评估了2009年至2017年间接受该手术的20例患者。中位年龄为56.5岁。12例（60%）患者病变位于左侧，6例（30%）患者病变位于右侧小脑，2例（10%）患者病变位于中线。
12例（60%）患者的立体定向框架倾斜安装，8例（40%）患者的框架垂直安装。术后CT扫描显示，2例（10%）患者有小的、临床上无症状的血肿，1例（5%）患者出现出血，导致脑积水。该患者接受了脑室外引流。在这2例有小出血的患者中，框架均垂直放置，而在出现较大出血的患者中，框架倾斜安装。所有患者均获得了最终的组织病理学诊断。
对于性质不明的小脑病变，可通过垂直或倾斜安装的立体定向框架经小脑入路进行活检。对于小脑病变，该手术也显示出较高的诊断率和较低的严重并发症发生率，这些并发症需要进一步治疗。
