Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Division for Stereotactic Neurosurgery, Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Neurosurg Rev. 2024 Nov 1;47(1):832. doi: 10.1007/s10143-024-03075-8.
Both the transfrontal and the suboccipital-transcerebellar approach are frequently used trajectories for frame-based stereotactic biopsies of brainstem lesions. Nevertheless, it remains unclear which approach is more favorable in terms of complications, diagnostic success and outcome, especially considering the location of the lesion within the brainstem. This study compared the safety and diagnostic yield of these two approaches. Furthermore, a brainstem zone model was created to answer the question, whether there is a favorable approach depending on the location of the lesion in the brainstem. A retrospective analysis of 84 consecutive cases of frame-based stereotactic biopsies for brainstem lesions via either transfrontal or suboccipital-transcerebellar approaches over a 16-year period was performed. Clinical and surgical data regarding trajectories, histopathology, complications and outcome was collected. The brainstem was divided in anatomical zones to compare the use of the two approaches depending on the location of the lesions. A total of n = 84 cases of stereotactic biopsies for brainstem lesions were performed. In 36 cases the suboccipital-transcerebellar approach was used, while in 48 cases surgery was performed via the transfrontal approach. The patient's demographic data were comparable between the two approaches. Overall diagnostic yield was 90.5% (93.8% transfrontal vs. 86.1% suboccipital, p = 0.21, Risk Difference (RD) 0.077, CI [-0.0550, 0.2090]). Complications occurred in 11 cases (total complication rate: 13.1%; 12.5% transfrontal vs. 13.9% suboccipital, p = 0.55, RD 0.014, CI [-0.1607, 0.1327]). The brainstem model showed a more frequent use of the suboccipital approach in lesions of the dorsal pons. The transfrontal approach was used more frequently in mesencephalic targets. No significant differences in terms of complications and diagnostic yield were observed, even though complications in medullary lesions appeared higher using the transfrontal approach. This study showed, that if the approaches are used for their intended target locations there are no significant differences between the transfrontal and the suboccipital-transcerebellar approach for frame-based stereotactic biopsies of brainstem lesions in terms of diagnostic yield and safety. Therefore, our data suggests that both approaches should be considered for stereotactic biopsy of brainstem lesions.
经额和枕下小脑幕入路常用于基于框架的脑干病变立体定向活检。然而，在考虑病变在脑干内的位置的情况下，哪种方法在并发症、诊断成功率和结果方面更有利仍不清楚。本研究比较了这两种方法的安全性和诊断效果。此外，还创建了一个脑干分区模型来回答这样一个问题，即根据病变在脑干中的位置，是否存在一种有利的方法。对 16 年来通过经额或枕下小脑幕入路对 84 例连续的基于框架的脑干病变立体定向活检的临床和手术数据进行了回顾性分析。收集了关于轨迹、组织病理学、并发症和结果的临床和手术数据。将脑干分为解剖区，以比较两种方法在病变位置不同时的应用。共对 84 例脑干病变的立体定向活检进行了研究。其中 36 例采用枕下小脑幕入路，48 例采用经额入路。两种方法的患者人口统计学数据无差异。总的诊断成功率为 90.5%（经额入路 93.8%，枕下小脑幕入路 86.1%，p=0.21，风险差异 RD=0.077，95%置信区间 CI [-0.0550，0.2090]）。11 例发生并发症（总并发症发生率：13.1%；经额入路 12.5%，枕下小脑幕入路 13.9%，p=0.55，RD=0.014，95%置信区间 CI [-0.1607，0.1327]）。脑干模型显示，背侧脑桥病变更常采用枕下小脑幕入路，中脑病变更常采用经额入路。在并发症和诊断成功率方面，两种方法没有显著差异，尽管经额入路治疗延髓病变的并发症似乎更高。本研究表明，如果针对不同的靶点位置使用这些方法，那么在基于框架的脑干病变立体定向活检中，经额和枕下小脑幕入路在诊断成功率和安全性方面没有显著差异。因此，我们的数据表明，对于脑干病变的立体定向活检，这两种方法都应该被考虑。
