AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013, Paris, France; Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.
AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Médecine Interne et d'Immunologie Clinique, F-75013, Paris, France.
Eur J Intern Med. 2020 Oct;80:78-85. doi: 10.1016/j.ejim.2020.05.029. Epub 2020 Jul 10.
For nonneoplastic neurological diseases, no recommendation exists regarding the place or appropriate timing of brain biopsy. The aim of this study was to evaluate the diagnostic yield and safety of brain biopsies from patients with neurological diseases of unknown etiology.
We performed a retrospective cohort study from January 1, 2008 to December 31, 2018. We analyzed 1847 brain-biopsied patients, including 178 biopsies indicated for neurological diseases of unknown etiology. Specific histological and final diagnosis rates, positive diagnosis-associated factors, complication rate and complication-associated factors were assessed.
Specific histological diagnosis and final diagnosis rates were 71.3% and 83.1%, respectively, leading to therapeutic management change(s) for 75.3% of patients. Brain- biopsy-related mortality and permanent neurological morbidity occurred in 1.1% and 0.6% of the patients, respectively. The multivariable logistic-regression model retained (odds ratio [95% CI] only immunodepression (2.2 [1.1-4.7]; P=.04) as being independently associated with specific histological diagnosis, while supratentorial biopsy-targeted lesions (4.1 [1.1-15.2]; P=.04) were independently associated with a final diagnosis. Biopsies obtained from comatose patients were less contributive to the diagnosis (0.2 [0.05-0.7]; P=.01). Prebiopsy platelet count <100 G/L (28.5 [1.8-447]; P=.02), hydrocephalus (6.3 [1.2-15.3]; P=.02) and targeted lesions <1 cm (4.3 [1.2-15.3]; P=.03) were independently associated with brain biopsy-related complications.
For highly selected patients with neurological diseases of unknown etiology, brain biopsy has a high diagnostic yield and low frequency of severe complications. We advocate that this procedure be considered early in the diagnosis algorithm of these patients.
对于非肿瘤性神经疾病，目前尚无为明确病因的神经疾病患者进行脑活检的部位或适当时机的推荐。本研究旨在评估病因不明的神经疾病患者脑活检的诊断率和安全性。
我们进行了一项回顾性队列研究，时间范围为 2008 年 1 月 1 日至 2018 年 12 月 31 日。我们分析了 1847 例接受脑活检的患者，包括 178 例因病因不明的神经疾病而进行的活检。评估了特定组织学和最终诊断率、阳性诊断相关因素、并发症发生率和并发症相关因素。
特定组织学诊断和最终诊断率分别为 71.3%和 83.1%，分别导致 75.3%的患者治疗管理发生改变。脑活检相关死亡率和永久性神经功能障碍发生率分别为 1.1%和 0.6%。多变量逻辑回归模型仅保留免疫抑制（2.2 [1.1-4.7]；P=.04）作为与特定组织学诊断相关的独立因素，而上脑活检靶向病变（4.1 [1.1-15.2]；P=.04）与最终诊断相关。处于昏迷状态的患者的活检对诊断的贡献较小（0.2 [0.05-0.7]；P=.01）。活检前血小板计数<100 G/L（28.5 [1.8-447]；P=.02）、脑积水（6.3 [1.2-15.3]；P=.02）和靶向病变<1 cm（4.3 [1.2-15.3]；P=.03）与脑活检相关并发症独立相关。
对于病因不明的神经疾病的高度选择患者，脑活检具有较高的诊断率和较低的严重并发症发生率。我们主张在这些患者的诊断算法中尽早考虑进行该操作。
