Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Southern California Permanente Medical Group, San Diego, USA.
Neurosurg Rev. 2024 Oct 25;47(1):819. doi: 10.1007/s10143-024-03015-6.
Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0 min (IQR 49-83) versus 35.5 min (IQR 26-54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique.
立体定向无框架针脑活检是一种常见的神经外科手术，通过旋转钻头或开颅钻方法进行。我们旨在比较诊断率和手术结果，以阐明这两种方法的安全性和有效性。对一家机构 30 个月内进行的所有立体定向针活检手术的回顾性数据库进行了汇总。提取人口统计学、合并症、手术细节/并发症、术后即刻影像学和病理结果。确定了 225 例针活检，其中 165 例（73.3%）为开放式，60 例（26.7%）为旋转钻头式。开放式（84.8%）和旋转钻头式（93.3%）方法的诊断病理检出率相似（p=0.15），每个方法平均取 4 个核心（p=0.30）。在进行术中病理确认时暂停手术，诊断组织产量为 90.4%，而不停顿手术为 79.1%（p=0.036，OR 2.49）。与开放式手术相比，旋转钻头手术的中位手术时间分别为 68.0 分钟（IQR 49-83）和 35.5 分钟（IQR 26-54）（Wilcoxon p<0.001），在使用双变量线性模型控制术中等待病理结果后，差异仍然显著（p<0.001）。22 例患者（9.8%）术中经针套管出血，其中 8 例为旋转钻头（13.3%），14 例为开放式（8.5%）。197 例（87.6%）术后行头颅 CT/MRI 检查，90 例（45.7%）有不同程度的术后出血，表现为浅表（n=10，11.1%）、深部/瘤内（n=64，71.1%）出血或两者兼有（n=16，17.9%）。开放式（46.7%）和旋转钻头（43.3%）方法的出血率相似（p=0.78）。9 例（4.0%）患者术后出现临床恶化或神经功能改变，其中 1 例为旋转钻头（1.7%），8 例为开放式（4.8%），其中 7 例（78%）术后影像学显示深部有血液产物。与传统开颅钻针活检相比，立体定向旋转钻头针活检具有相似的诊断率、无症状性出血率和术后并发症，手术时间更短，切口更小。术中使用冷冻组织病理学检查以获得足够的诊断组织，无论采用何种方法，都可能提高最终的病理诊断率。
