805例立体定向脑活检报告

Stereotactic biopsy for the brain lesions:experience of 805 cases

目的 探讨立体定向脑活检方法的可靠性和安全性 ,研究手术方法及技术要点。方法 回顾性分析80 5例立体定向手术对脑深部病灶活检病理学检查。其中用CT引导活检 6 0 5例 ,MR引导活检 2 0 0例 ;幕上脑深部活检 6 4 5例 ,幕下病灶活检 16 0例 ;单道入路活检取材 5 30例 ,多道入路活检取材 2 0 5例 ,多发病灶活检取材 70例。结果 710例 (88 2 0 % )获取各类脑肿瘤的病理学诊断 ,5 0例 (6 2 1% )为炎性病理 ,2 5例 (3 11% )为寄生虫或囊肿类病理 ,其余 2 0例 (2 4 8% )所取得的病理组织未能提供正确的病理定性诊断。病理阳性诊断率为 97 5 2 % ,肿瘤发现率为 88 2 0 % ,死亡 3例 ,死亡率 0 37% ,并发症发生 19例 (2 36 % )。结论 现代立体定向脑深部病灶活检技术安全、可靠。

Objective To evaluate the safety and accuracy of minimally invasive stereotactic biopsy of the brain, explore the operation method and technical note. Methods 805 cases with brain lesions receiving minimally invasive stereotactic biopsy surgery were retrospectively analyzed. All the procedures were done by using Leksell stereotactic system. Of them, 605 patients underwent the stereotactic biopsies guided by CT, while the other 200 patients guided by MR. 645 patients presented with supratentorial lesions and 160 with infratentorial lesions. Single sampling biopsies through one biopsy trajectory were performed in 530 patients and via multiple biopsy needle tracks in 205, as well as multiple sampling biopsies of multiple lesions in 70. Results Brain tumors were diagnosed pathologically in 710 patients(88 20%), inflammatory brain lesions in 50(6 21%), parasitic disease or cystic lesions in 25(3 15%). Altogether 97 35% patients were diagnosed pathologically by brain biopsy. In the other 20 patients, biopsy failed to make pathological diagnosis since no specific changes were found. Complications related to biopsy surgery occurred in 19 patients(2 36%) and 3 died (0 37%). Conclusions The result suggests that the minimally invasive stereotactic biopsy represents a safe and reliable method for pathological diagnosis of brain lesions with low potential risk of complications.