Javedan S P, Tamargo R J
Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Neurosurgery. 1997 Oct;41(4):823-8; discussion 828-30. doi: 10.1097/00006123-199710000-00011.
The diagnostic yield and therapeutic implications of brain biopsy were determined in a series of 50 consecutive brain biopsies that were performed in 48 patients between 1990 and 1995 at The Johns Hopkins Hospital to assess progressive neurodegenerative disorders of unclear origin.
Severely immunocompromised patients and patients undergoing biopsies for suspected neoplastic lesions were excluded from this analysis. Before surgery, the patients had undergone extensive laboratory and radiographic tests, including lumbar puncture (all 48 patients), electroencephalography (26 of 48 patients), magnetic resonance imaging (all 48 patients), and angiography (17 of 48 patients). Despite the results of these studies, diagnoses could not be established, and thus, brain biopsies were undertaken.
Only 10 of the 50 biopsies (44 open procedures and 6 stereotactic procedures) led to diagnoses, resulting in a diagnostic yield of 20%. An additional three biopsies (6%) were only suggestive of diagnoses. The results of 33 biopsies (66%) were abnormal but nonspecific, and the results of 4 (8%) were normal. Minor complications associated with biopsy occurred in five cases (10%), and there were no deaths. Of the 10 patients whose biopsies were diagnostic, only 4 underwent meaningful therapeutic intervention as a result of the procedure, resulting in an overall therapeutic benefit in only 8% of all the cases. An analysis of patient subgroups to elucidate a correlation with diagnostic biopsy revealed that patients with focal magnetic resonance imaging findings had the highest likelihood of a diagnostic biopsy (odds ratio, 4.00). Electroencephalography and laboratory abnormalities were not predictive of a diagnostic biopsy.
We conclude that the current diagnostic yield (20%) of brain biopsy for progressive neurodegenerative disorders is lower than that of earlier reports and that the therapeutic benefits of the procedure are limited.
在1990年至1995年间于约翰霍普金斯医院对48例患者进行的连续50次脑活检中，确定脑活检的诊断率及其治疗意义，以评估病因不明的进行性神经退行性疾病。
本分析排除了严重免疫功能低下的患者以及因疑似肿瘤性病变而接受活检的患者。手术前，患者接受了广泛的实验室和影像学检查，包括腰椎穿刺（所有48例患者）、脑电图检查（48例患者中的26例）、磁共振成像（所有48例患者）和血管造影（48例患者中的17例）。尽管进行了这些检查，但仍无法确诊，因此进行了脑活检。
50次活检中（44次开放手术和6次立体定向手术）仅有10次得出诊断结果，诊断率为20%。另有3次活检（6%）仅提示可能的诊断。33次活检（66%）结果异常但不具有特异性，4次活检（8%）结果正常。活检相关的轻微并发症发生在5例患者中（10%），无死亡病例。在10例活检有诊断结果的患者中，只有4例因该检查接受了有意义的治疗干预，仅占所有病例的8%。对患者亚组进行分析以阐明与诊断性活检的相关性，结果显示磁共振成像有局灶性表现的患者进行诊断性活检的可能性最高（优势比为4.00）。脑电图检查和实验室异常并不能预测诊断性活检结果。
我们得出结论，目前脑活检对进行性神经退行性疾病的诊断率（20%）低于早期报告，且该检查的治疗益处有限。
