影响立体定向活检的相关因素分析

Analysis of the relative factors affecting stereotactic biopsy for deep brain lesions

目的：探讨影响立体定向活检的相关因素。方法：回顾性总结１９９４年１２月至２０００年６月间我科收治并行ＭＲＩ导向立体定向活检的１５６例病例。患者年龄６～７２岁，平均４５．５岁；其中男８９例，女６７例；病灶位于鞍区５例，基底节区３３例，松果体区４６例，中脑２例，侧脑室壁２例，三脑室底部２例，额叶深部２８例，颞叶９例，顶枕叶６例，多发性病灶２３例。手术采用Ｌｅｋｓｅｌｌ—Ｇ型定向仪和１．０ＴＭＲ机（Ｓｉｅｍｅｎｓ）。所有靶点活检均采用Ｓｅｄａｎ侧方开口活检针，标本立即行快速冰冻病检。结果：病理诊断阳性率９７．４％（１５２例），其中低级别星型胶质瘤２４例，高级别星型胶质瘤２８例，室管膜瘤２例，转移瘤３３例，感染性病灶２９例，生殖细胞瘤３１例，松果体母细胞瘤２例，垂体腺瘤１例，淋巴瘤２例，阴性４例。活检出血２例，术中癫痫发作１例，并发症发生率１．９％。全组病例无死亡。结论：影像导向立体定向活检术是一种安全、定位精确、高诊断率的微侵袭性脑深部疑难病变定性诊断方法。其影响因素包括影像定位技术、靶点及活检通道选择、活检器械选择、并发症防治等。

Objective: To investigate the relative factors that affect imaging - guided stereotactic biopsy for deep brain lesions. Methods: 156 patients whom between December 1994 and June 2000 un- derwent MRI - guided stereotactic biopsy were analyzed retrospectively. The patients were aged be- tween 6 and 72 (mean45. 5) years. There were 89 males and 67 females. The lesions were located in sellar area in 5, basal ganglion in 33, pineal region in 46, brain stem in 2, wall of lateral ventricle in 2, posterior third ventricle in 2, frontal lobe in 28, temporal lobe in 9, occipital lobe and parietal lobe in 6, multiple in 23. We used Leksell - G system and 1. 0 - Tesla magnetic resonance system(Siemens). We performed biopsies for each target using a Sedan side - cutting needle. Intraoperative frozen section of specimens was made immediatecy. Results: Diagnostic yield was 97. 4 % (152 cases). The result of the pathological diagnosis was high - grad glioma in 28, olwgrad glioma in 24, ependynoma in 2, metastase in 33, inflammatory lesion in 29, germinoma in 31, pinealoblastomas in 2, pituitary adenoma inl, lym- phoma in 2, and negative in 4. No mortality related to the surgery occurred in this series. The morbidity rate was 1. 9 % (three cases), two cases showed asymptomatic hemorrhage, one case showed seizure during operation. Conclusions: MRI - guided stereotactic biopsy is a safe, accurate, effective method for evaluatiing deep brain lesions. The factors that affect imaging - guided stereotactic biopsy include imag- ing technique, complex surgical planning with target choice and biopsy trajectory, biopsy instrument, the prevention and management of complication.