Morawetz R B, Whitley R J, Murphy D M
Neurosurgery. 1983 Jun;12(6):654-7. doi: 10.1227/00006123-198306000-00011.
From January 1973 through July 1981, 40 patients underwent brain biopsy for suspected herpes simplex encephalitis at the University of Alabama Medical Center. Biopsy was performed as a component of experimental antiviral studies to ensure correct diagnosis. A tentative diagnosis was made on clinical grounds, and the site of biopsy was chosen on the basis of localizing neurological signs, the electroencephalogram, and/or computed tomographic (CT) scan abnormalities. Patients ranged in age from 15 months to 73 years, with a median age of 19 years. Thirty patients were male, and 10 were female. Brain tissue from 17 of the 40 patients grew herpes simplex virus in tissue culture. There was one biopsy-related complication, a wound dehiscence requiring secondary closure. In no case was death attributable to the brain biopsy procedure. The outlook in patients with proven herpes encephalitis worsened directly with both an increasing interval between the onset of symptoms and the initiation of antiviral therapy and the age of the patient. The presence of a CT scan abnormality before the initiation of therapy was associated with a very poor prognosis. Three patients not included in this series were referred for brain biopsy to rule out herpes simplex encephalitis, but were found to have bacterial infections. Two had subdural empyemas and the third had a brain abscess with overlying subdural empyema. Current technique calls for biopsy of the anterior portion of the inferior temporal gyrus on the affected side.
1973年1月至1981年7月，阿拉巴马大学医学中心有40例疑似单纯疱疹性脑炎的患者接受了脑活检。活检作为实验性抗病毒研究的一部分进行，以确保正确诊断。根据临床症状做出初步诊断，并根据定位性神经体征、脑电图和/或计算机断层扫描（CT）异常来选择活检部位。患者年龄从15个月至73岁不等，中位年龄为19岁。30例为男性，10例为女性。40例患者中有17例的脑组织在组织培养中培养出单纯疱疹病毒。有1例活检相关并发症，即伤口裂开需要二次缝合。无一例死亡归因于脑活检手术。确诊为疱疹性脑炎的患者的预后直接随着症状出现与开始抗病毒治疗之间间隔时间的延长以及患者年龄的增加而恶化。治疗开始前CT扫描异常与预后极差相关。本系列未纳入的3例患者因排除单纯疱疹性脑炎而被转诊进行脑活检，但发现患有细菌感染。2例患有硬膜下积脓，第3例患有脑脓肿并伴有硬膜下积脓。目前的技术要求对患侧颞下回前部进行活检。
