Objective: To investigate the value of stereotactic biopsy in the accurate diagnosis of lesions in the brain stem and deep brain. Methods: A total of 29 consecutive patients who underwent stereotactic biopsy of brainstem and deep brain lesions between May 2012 and January 2018 were retrospectively reviewed. The Cosman-Roberts-Wells (CRW) stereotactic frame was installed under local anesthesia. Thin-layer CT and MRI scanning were performed. Target coordinates were calculated by inputting CT-MRI data into the radionics surgical planning system. The individualized puncture path was designed according to the location of the lesions and the characteristics of the image. Target distributions were as follows: 12 cases of midbrain or pons, 2 cases of internal capsule, 3 cases of thalamus, 12 cases of basal ganglia. The biopsy samples were used for further pathological and/or genetic diagnosis. Results: Twenty-eight of the 29 cases (96.6%) were diagnosed accurately by histopathology and genomic examination following stereotactic biopsy. Pathological results were as follows: 8 cases of lymphoma, 7 cases of glioma, 4 cases of demyelination, 2 cases of germ cell tumor, 2 cases of metastatic tumor, 1 cases of cerebral sparganosis, 1 case of tuberculous granuloma, 1 case of hereditary prion disease, 1 case of glial hyperplasia, 1 case of leukemia. The accurate diagnosis of one case required a combination of histopathology and genomic examination. Undefined diagnosis was still made in 1 cases (3.45%) after biopsy. After biopsy, there were 2 cases (6.9%) with symptomatic slight hemorrhage, 1 case (3.45%) with symptomatic severe hemorrhage, and 1 cass (3.45%) with permanent neurological dysfunction. No one died because of surgery or surgical complications. Conclusions: Stereotactic biopsy is fast, safe and minimally invasive. It is an ideal strategy for accurate diagnosis of lesions in brain stem and deep brain.
目的： 探讨立体定向活检术在脑深部、脑干疑难病变精准诊断中的价值。 方法： 回顾性分析我院2012年5月至2018年1月期间完成的29例脑干、脑深部疑难病变立体定向活检手术结果。手术在局麻下安装CRW立体定向框架，螺旋CT薄层扫描，将CT、MRI数据输入Radionics手术计划系统，行CT－MR融合定位，计算靶点坐标。根据病灶位置、神经影像特征，设计个体化穿刺路径进行活检。靶点位置分布：中脑、桥脑12例，内囊2例，丘脑3例、基底节12例，进行组织病理学和(或)基因学检测，明确诊断。 结果： 29例患者中，28例(96.6%)经立体定向活检后病理/基因学检测获得确诊。病理结果：淋巴瘤8例，胶质瘤7例，脱髓鞘4例，生殖细胞瘤2例，转移瘤2例，脑裂头蚴病1例，结核性肉芽肿1例，遗传性朊病毒病1例，胶质增生1例，单核细胞白血病中枢浸润1例。其中病理＋基因学确诊1例，诊断不明1例(3.45%)。术后症状性小出血2例(6.9%)，大出血1例(3.45%)，遗留永久性神经功能障碍1例(3.45%)，无手术死亡。 结论： 立体定向活检术具有快速、微创、安全的特点，是脑干、脑深部疑难病变精准诊疗的理想策略。.
Keywords: Biopsy; Brainstem; Diagnosis; Stereotactic.