Nauta H J, Briner R P, Eisenberg H M
Pediatr Neurosci. 1985;12(1):63-7. doi: 10.1159/000120220.
Experience with computed tomogram-guided stereotactic biopsy is described with special reference to technical considerations important to the application of the Brown-Roberts-Wells system in pediatric patients. Eleven procedures were performed in 9 patients aged 9 months to 16 years of age. In all cases, the lesion was either deep seated or related to deficit prone areas making open biopsy hazardous. Since the stereotactic frame may interfere with intubation, it is important to apply it only after the patient has been anesthetized and intubated. In very small children, special attention is required to avoid over tightening of the fastening pins and to avoid excessive pressure when making the calvarial opening. In an effort to reduce the risk of hemorrhage, vasculature at the entry site was visualized and avoided by making a standard burr hole opening. Improved imaging of the vasculature at the deep biopsy site was obtained in most cases by intra-arterial contrast enhancement. No complications of the procedure were encountered and a diagnosis was obtained in all cases, although in 2 cases the procedure was repeated before adequate tissue was obtained. In 3 cases the procedure was therapeutic as well as diagnostic in that a tumor cyst or abscess could be drained.
本文描述了计算机断层扫描引导下的立体定向活检经验，特别提及了对布朗-罗伯茨-韦尔斯系统应用于儿科患者至关重要的技术考量。对9例年龄在9个月至16岁的患者进行了11次手术。在所有病例中，病变要么位于深部，要么与易出现功能缺损的区域相关，这使得开放性活检具有危险性。由于立体定向框架可能会干扰插管，因此仅在患者麻醉并插管后应用该框架非常重要。对于非常小的儿童，需要特别注意避免过度拧紧固定针，并在进行颅骨开口时避免施加过大压力。为了降低出血风险，通过制作标准的骨孔开口来观察并避开穿刺部位的血管。在大多数情况下，通过动脉内造影剂增强可改善深部活检部位血管的成像。该手术未出现并发症，所有病例均获得了诊断，尽管有2例在获得足够组织之前重复了手术。在3例病例中，该手术兼具治疗和诊断作用，因为可以引流肿瘤囊肿或脓肿。
