内窥镜立体定向活检术在颅内病变诊断中的应用

The application of stereotactic endoscopic biopsy in the diagnosis of the intracranial lesions

目的探讨内窥镜立体定向活检术的准确性及其在颅内病变诊断中的临床价值。方法回顾性总结2009年1月至2013年6月间昆明医科大学第一附属医院神经外二科收住院并行内窥镜立体定向活检术的16例病例，患者年龄6～59岁（平均38．8岁），其中男性患者10例，女性患者6例；病变位于额叶5例，颞叶2例，顶叶2例，枕叶1例，基底节区1例，多发病变5例。结果病理诊断阳性率87．5％（14例），其中炎性肉芽肿4例，星形细胞瘤wHOI-Ⅱ级3例，星形细胞瘤WHOⅡ级2例，毛细胞星形细胞瘤wHOI级1例，混合型少突一星形细胞瘤WHOⅡ级1例，多形性胶质母细胞瘤WHOIV级1例，弥漫性大B细胞淋巴瘤1例，颅内肉芽肿性动脉炎1例，阴性2例。无术后昏迷、偏瘫、感染、颅内出血等严重并发症。结论内窥镜立体定向活检术是颅内病变诊断的重要方法之一，定位精确、创伤小、安全可靠、有效减少并发症的发生、值得推广。

Objective To investigate the accuracy and role of stereotactic endoscopic biopsy in the diagnosis of the intracranial lesions. Methods 16 patients in the first affiliated hospital of Kunming Medical University underwent stereotactic endoscopic biopsy were analyzed retrospec- tively from January 2009 to June 2013. The patients were aged between 6 and 59 years（mean age 38. 8 years）. There were 10 males and 6 femals. The lesions were located in front lobe in 5, tem- poral lobe in 2, parietal lobe in 2,occipital lobe in 1, basal ganglion in 1, multiple in 5. Results Diagnostic yield was 87.5% （14 cases）. The result of the pathological diagnosis was inflammatory granuloma in 4,astrocytoma in 3（WHO I --II ）, astrocytoma in 2（WHO II ）,pilocytic astrocyto- ma inl（WHO I ）, mixed oligoastrocytoma in 1 （WHO ]] ）, glioblastoma multiforme in 1 （WHO IV）, diffuse large B--cell lymphoma in 1, intracranial granulomatousarteritis in 1,and negative in 2. There were no serious complications, such as coma, hemiparalysis,infection and intraeranial he- matoma. Conclusion Stereotactic endoscopic biopsy is an important method in the diagnosis of intracranial lesions. It has the advantages of precise location, less damage, safe performance, re-ducing the complication effectively. It is worth advocating.