Hersh David S, Kumar Rahul, Moore Kenneth A, Smith Luke G F, Tinkle Christopher L, Chiang Jason, Patay Zoltan, Gajjar Amar, Choudhri Asim F, Lee-Diaz Jorge A, Vaughn Brandy, Klimo Paul
1Division of Neurosurgery, Connecticut Children's, Hartford.
2Department of Surgery, UConn School of Medicine, Farmington, Connecticut.
J Neurosurg Pediatr. 2020 Jul 31;26(5):552-562. doi: 10.3171/2020.4.PEDS2092. Print 2020 Nov 1.
Biopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection.
All patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected.
A total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9-14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis.
Brainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.
在临床或影像学表现不典型的情况下，进行脑干病变活检以明确诊断，或促进分子研究。更好地了解脑干活检的安全性和诊断率将有助于指导合适的患者选择。
回顾了2011年1月至2019年6月期间所有接受脑干病变活检的患者。收集了人口统计学、影像学、手术和结果数据。
在研究期间，共有58例患者接受了65次脑干活检。总体而言，中位年龄为7.6岁（四分位间距3.9 - 14.2岁）。65次活检中有22次（34%）为开放性活检，42次（65%）为立体定向活检，1次为内镜活检。3例（5%）患者放置了脑室腹腔分流管，9例（14%）患者在与活检相同的手术过程中进行了后颅窝减压。28例（43%）患者进行了术中磁共振成像（iMRI）。其中3例（11%）活检未命中靶点，在同一手术过程中获取了额外样本。5例（8%）患者出现了新的神经功能缺损，包括感觉缺损、眼肌麻痹/眼球震颤、面部无力和听力丧失；这些缺损在2例患者中持续存在，3例为短暂性。1例患者发生了假性脑脊膜膨出；无患者发生脑脊液漏或感染。8例（13%）患者需要额外的检查来明确诊断。
脑干活检安全有效。靶点选择和手术入路应共同决定。iMRI可用于实时评估活检准确性，从而在必要时进行调整。
