Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Adv Tech Stand Neurosurg. 2024;53:139-157. doi: 10.1007/978-3-031-67077-0_9.
Brainstem tumors account for 10-20% of pediatric brain tumors with a peak age of diagnosis between 7 and 9 years old and are often fatal. Historically, diagnosis of brainstem tumors has been largely based on imaging; however, recent studies have demonstrated the incongruities between preoperative MRI diagnosis and postoperative pathological findings highlighting the importance of brainstem biopsy for diagnostic accuracy. Stereotactic brainstem biopsy for pediatric brainstem tumors has been proven to be safe with a high diagnostic yield (96.1-97.4%) and relatively low morbidity and mortality. Successful pediatric brainstem tumor biopsy demands intricate knowledge of brainstem anatomy, cranial nerves and vasculature, and common pediatric brainstem tumors by the performing surgeon. Additionally, understanding of the surgical indications and techniques (e.g., frame-based versus frameless, robotic assistance, surgical approach, and targets selection) helps to ensure maximal safety and tissue yield. Pediatric brainstem biopsy permits histological conformation of brainstem lesions leading to accurate diagnosis and the potential for personalized treatment and future therapeutic research.
脑干肿瘤占儿童脑肿瘤的 10-20%，诊断高峰年龄在 7 至 9 岁之间，通常是致命的。历史上，脑干肿瘤的诊断主要依赖于影像学；然而，最近的研究表明，术前 MRI 诊断与术后病理发现之间存在不一致之处，突出了脑干活检对诊断准确性的重要性。对于儿童脑干肿瘤，立体定向脑干活检已被证明是安全的，具有较高的诊断率（96.1-97.4%），且发病率和死亡率相对较低。成功的儿童脑干肿瘤活检需要术者对脑干解剖结构、颅神经和血管以及常见的儿童脑干肿瘤有深入的了解。此外，了解手术适应证和技术（如框架与无框架、机器人辅助、手术入路和靶点选择）有助于确保最大程度的安全性和组织产量。儿童脑干活检可对脑干病变进行组织学确认，从而进行准确诊断，并为个性化治疗和未来的治疗研究提供可能。
