Natt Muhammad Aqeel, Khizar Ahtesham, Qadri Haseeb Mehmood, Tanweer Maryem, Bashir Raahim, Baig Abdur Rehman, Hasan Muhammad Nauman, Bashir Asif
Dr. Muhammad Aqeel Natt, MBBS, FCPS Assistant Professor Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
Dr. Ahtesham Khizar, MBBS, FCPS Senior Registrar Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
Pak J Med Sci. 2024 Dec;40(12PINS Suppl):S6-S14. doi: 10.12669/pjms.40.12(PINS).11106.
To evaluate the precision and safety of a novel technique of free-hand frameless pinless AXIEM™-based navigation guided biopsy of deep-seated brain lesions in a low-middle income country.
This retrospective study included 45 patients who underwent free-hand frameless pinless AXIEM™-based navigation guided biopsy of deep-seated brain lesions using the Medtronic-Stealth S7 system over a 5-year period (January 2019 to December 2023) at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan.
A total of 45 patients were included in this study. There were 4 (8.9%) patients in the 1 to 20 years age group, 10 (22.2%) in 21 to 40 years, 24 (53.3%) in 41 to 60 years and 7 (15.6%) were above 60 years. Mean age (years) was 47.29 ± 17.192 SD. Mean time (minutes) for procedures was 37.87 ± 9.6 SD. There were 28 (62.2%) male and 17 (37.8%) female patients. Among patients reviewed in this study 2 (4.4%) had lesions in Corpus Callosum, 8 (17.8%) in Lobar region, 5 (11.1%) were Multiple/Metastatic and 30 (66.7%) were in Thalamus/Internal Capsule/Basal Ganglia. Size of lesions was less than 1 cm in 4 (8.9%) cases, 1-2 cm in 29 (64.4%) and 2 to 3 cm in 12 (26.7%) cases. There were 18 (40%) patients with lesions on the left side, 21 (46.7%) on the right side, 4 (8.9%) bilateral and 2 (4.4%) in the midline. Most cases were performed in local (40%) or local with IV sedation (48.9%) and a few in general anesthesia (11.1%). Biopsy results were successfully diagnostic in 40 (88.9%) and non-diagnostic in 5 (11.1%) patients. Glioblastoma WHO Grade IV was seen in 20 (44.4%) patients, Diffuse Astrocytoma WHO Grade II in 5 (11.1%), Anaplastic Astrocytoma WHO Grade III in 2 (4.4%), Pleomorphic Xanthoastrocytoma in 1 (2.2%), Lymphoma in 7 (15.6%) and Metastasis in 5 (11.1%) patients. Asymptomatic minor haemorrhage was seen in 3 (6.7%) patients, massive haemorrhage in 2 (4.4%), hydrocephalus in 1 (2.2%), surgical site infection in 1 (2.2%) and 38 (84.4%) patients had no complications.
AXIEM™-based Medtronic-Stealth S7 is a quick, reliable, real-time and secure neuronavigation system for taking a free-hand, frameless and pinless biopsy of deep-seated lesions in the brain.
评估一种基于无框架徒手AXIEM™导航的新技术在低收入和中等收入国家对深部脑病变进行活检的准确性和安全性。
这项回顾性研究纳入了45例患者，他们在2019年1月至2023年12月的5年期间，于巴基斯坦拉合尔旁遮普神经科学研究所神经外科，使用美敦力Stealth S7系统，接受了基于无框架徒手AXIEM™导航的深部脑病变活检。
本研究共纳入45例患者。1至20岁年龄组有4例（8.9%），21至40岁有10例（22.2%），41至60岁有24例（53.3%），60岁以上有7例（15.6%）。平均年龄（岁）为47.29±17.192标准差。手术平均时间（分钟）为37.87±9.6标准差。男性患者28例（62.2%），女性患者17例（37.8%）。在本研究纳入的患者中，2例（4.4%）病变位于胼胝体，8例（17.8%）位于脑叶区域，5例（11.1%）为多发/转移瘤，30例（66.7%）位于丘脑/内囊/基底节。4例（8.9%）病例病变大小小于1厘米，29例（64.4%）为1至2厘米，12例（26.7%）为2至3厘米。18例（40%）患者病变位于左侧，21例（46.7%）位于右侧，4例（8.9%）为双侧，2例（4.4%）位于中线。大多数病例在局部麻醉（40%）或局部麻醉加静脉镇静（48.9%）下进行，少数在全身麻醉（11.1%）下进行。活检结果在40例（88.9%）患者中成功诊断，5例（11.1%）未诊断。20例（44.4%）患者为世界卫生组织IV级胶质母细胞瘤，5例（11.1%）为世界卫生组织II级弥漫性星形细胞瘤，2例（4.4%）为世界卫生组织III级间变性星形细胞瘤，1例（约2.2%）为多形性黄色星形细胞瘤，7例（15.6%）为淋巴瘤，5例（11.1%）为转移瘤。3例（6.7%）患者出现无症状小出血，2例（4.4%）出现大出血，1例（2.2%）出现脑积水，1例（2.2%）出现手术部位感染，38例（84.4%）患者无并发症。
基于AXIEM™的美敦力Stealth S7是一种快速、可靠、实时且安全的神经导航系统，可用于对脑深部病变进行徒手、无框架和无针活检。
