■考虑到其最小的侵入性,立体定向活检(STB)是一种潜在的诊断工具,高诊断率,和最小的相关并发症。多年来,各种基于框架的仪器系统和无框架的立体定向活检系统已出现在临床使用中。通过这项研究,我们打算通过减少STB形式的治疗来获得更多的治疗,对于在过去5年中治疗的怀疑颅内病变的患者。我们还想强调在头皮块下进行手术的技术,它可以在许多临床场景中用作通用工具。即使在农村地区级的医疗机构中,也可以计划进行立体定向活检。购买仪器和利用现有成像的一次性投资可以导致在许多可疑病例中建立明确的诊断。这将导致较低的成本和治疗的早期建立。决定结果的独立风险因素,比如深层病变,相关水肿,术中高血压,被研究过。建立诊断有助于预测疾病,解释症状的自然进展,开始辅助治疗.这种组织活检也有助于确保样本用于研究和分子分析。
■2018年1月至2022年12月期间,有20名患者在我们的机构接受了STB。我们回顾性分析了患者的特征,肿瘤病理学,外科手术,和结果,包括诊断价值和手术相关并发症。对这些患者进行了随访,并对其无进展生存期和总生存期进行分析.注意并分析了对辅助治疗的需要。所有程序均使用CosmanRobertsWells®立体定向框架进行。入院时进行术前磁共振扫描。进行帧应用后的对比增强计算机断层扫描(CT)扫描以识别目标并计算坐标。进行术后CT扫描以确认目标病变的可及性。
■肿瘤最常见的位置是丘脑深部病变。在第一次STB时,对19名患者(95%)进行了明确的诊断。55%的病例诊断为神经胶质瘤,原发性中枢神经系统淋巴瘤,结核病,以及10%的脱髓鞘疾病,1例转移性脑肿瘤(5%)。术后并发症均为一过性,除一名患者运动无力恶化外。注意到后续行动,并记录这些患者所需的辅助治疗方式.
■立体定向活检是一种有用且有效的方法,可用于明确诊断并帮助治疗雄辩区域内或周围的多灶性或较小的深层病变。
UNASSIGNED: Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis.
UNASSIGNED: Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion.
UNASSIGNED: The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded.
UNASSIGNED: Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions.