Vilela-Filho Osvaldo, Porfírio Jairo, Goulart Lissa C
Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás, Goiânia, Brazil.
Surg Neurol Int. 2022 Jun 17;13:251. doi: 10.25259/SNI_246_2022. eCollection 2022.
Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting.
Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers.
Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified.
This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.
确认立体定向活检是否在正确部位进行通常依赖于冰冻切片或尚未广泛应用的新型肿瘤特异性标志物。在我们科室，活检后常规进行术后即刻计算机断层扫描（CT）或磁共振成像（MR）。在这项回顾性研究中，我们仔细分析了这些图像，试图确定指示合适靶点的标志物的存在情况。
回顾了接受颅内病变立体定向活检患者的病历和神经影像。评估了以下变量：年龄、性别、解剖病理学、病变部位、并发症、诊断准确性以及图像标志物的存在情况。
本病例系列纳入了29例患者。根据永久切片，约96.6%的活检是准确的。术后影像显示86.2%的患者病变内有积气，其中51.7%还伴有瘀点出血。在13.8%的病例中，未发现图像标志物。
这是关于病变内积气和瘀点出血作为立体定向活检合适靶点指示物的首次报告。在大多数情况下，广泛可用的术后即刻头部CT能够评估靶点的合适程度。为了将病变内积气/瘀点出血不仅用作术后而且用作术中合适靶点的标志物，建议在活检后暂时关闭手术伤口并包扎，以便患者能够进行CT/MR扫描，并在移除立体定向框架之前检查这些标志物的存在情况。
