Fukami Shinjiro, Nagai Kenta, Nakajima Nobuyuki, Onodera Sho, Akimoto Jiro, Kohno Michihiro
Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-023, Japan.
Department of Neurosurgery, Kohsei Chuo General Hospital, Tokyo, Japan.
Neurosurg Rev. 2025 May 29;48(1):460. doi: 10.1007/s10143-025-03636-5.
Neuroendoscopic biopsy has various advantages, such as being able to collect larger tissue samples and achieving more efficient hemostasis compared to needle biopsy. The purpose of this study is to review the surgical techniques, accuracy of pathological diagnosis, and perioperative complications of patients with intracerebral malignant lymphoma who were diagnosed mainly by neuroendoscopic biopsy.
A total of 65 patients diagnosed as having malignant lymphoma, via mainly neuroendoscopic biopsy, were analyzed retrospectively. A flexible neuroendoscope was used for ventricular and paraventricular lesions, which was inserted via the lateral ventricle. For intraparenchymal lesions, rigid scopes with navigation systems were used.
The main location of the tumors was in the intraventricular/paraventricular regions in 22 patients, in the deep white matter in 22 patients, in the basal ganglia in 14 patients, and in the cerebellum in 5 patients. Two patients had a lymphomatosis cerebri-like lesion. Lymphoma was diagnosed in 58 of the 65 patients, with most patients diagnosed as having diffuse large B-cell lymphoma. Incorrect diagnoses were owing to inappropriate samples, sentinel lesions, or preoperative treatments, such as with steroids. Complications included small cerebral hematoma in 5 patients, severe cerebral edema in 3 patients (2 fatal), and brain abscess and arterial bleeding leading to infarction in 1 case each.
Neuroendoscopic biopsy is a reliable diagnostic approach for intracranial malignant lymphomas, particularly those in deep or intraventricular/paraventricular locations. However, caution is particularly required for patients with severe cerebral swelling, which may cause death, and those with prior sentinel lesions.
神经内镜活检具有多种优势，例如与针吸活检相比，能够采集更大的组织样本并实现更有效的止血。本研究的目的是回顾主要通过神经内镜活检诊断的脑内恶性淋巴瘤患者的手术技术、病理诊断准确性及围手术期并发症。
回顾性分析65例主要通过神经内镜活检诊断为恶性淋巴瘤的患者。对于脑室及脑室旁病变，使用可弯曲神经内镜经侧脑室插入。对于脑实质内病变，使用带有导航系统的硬质内镜。
肿瘤主要位于脑室/脑室旁区域的有22例患者，位于深部白质的有22例患者，位于基底节的有14例患者，位于小脑的有5例患者。2例患者有脑淋巴瘤病样病变。65例患者中有58例诊断为淋巴瘤，大多数患者诊断为弥漫性大B细胞淋巴瘤。诊断错误是由于样本不合适、前哨病变或术前使用类固醇等治疗。并发症包括5例患者出现小脑小血肿，3例患者出现严重脑水肿（2例死亡），1例患者出现脑脓肿和动脉出血导致梗死。
神经内镜活检是颅内恶性淋巴瘤，尤其是深部或脑室/脑室旁部位淋巴瘤的可靠诊断方法。然而，对于可能导致死亡的严重脑肿胀患者以及有前哨病变的患者尤其需要谨慎。
