Spinal cord biopsy: A review of 38 cases
Spinal cord biopsy: A review of 38 cases
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DOI：
10.1227/01.neu.0000053223.77641.5e
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发表时间：
2003-04-01
期刊：
影响因子：
4.8
通讯作者：
Krauss, WE
中科院分区：
文献类型：
--
作者：
Cohen-Gadol, AA;Zikel, OM;Krauss, WE
目的：神经外科医生经常被要求评估病人的脊髓活检时，术前磁共振成像研究显示非特异性功能。这些病变通常表现为不可切除，但外科医生必须决定是否需要活检。为了确定这些情况下的最佳方法，我们评估了不明脊髓病变的患者进行脊髓biopsies.METHODS的临床病理结果：38个连续的患者进行脊髓活检在马约诊所（罗切斯特，MN）1988年8月至1998年7月进行了研究。详细审查的病历，放射学结果，手术记录，组织学检查结果，和outcomes were performed.RESULTS：脊髓活检进行了21名男性和17名女性患者（平均年龄，42.1岁）与脊髓病变相关的神经功能缺损进行。所有患者均接受术前磁共振成像评估。高T2加权信号强度和脊髓扩张分别在92%和87%的情况下，确定。钆注入后，大多数（94%）的炎性病变表现出斑片状，往往位于周边增强。这种神经放射学模式在肿瘤（50%）和良性病变（40%）中较少见。最常见的病理改变为脱髓鞘炎性改变或结节病，共13例（34%）。非特异性改变或良性病变10例（26%）。在8例病例（21%）中发现了新瘤。发现一例肺结核和一例血吸虫病，总的来说，47%的术前诊断是正确的。对于26%的患者，具体治疗是基于活检结果。平均随访时间为12个月（标准差，14个月;范围，0-50个月）。结论：术前实验室和影像学研究往往是诊断不确定的情况下，脊髓病变的非特异性功能。对于进行性症状性病变的患者，应考虑活检。
OBJECTIVE: Neurosurgeons are frequently asked to evaluate patients for spinal cord biopsies when preoperative magnetic resonance imaging studies demonstrate nonspecific features. These lesions often appear unresectable, but surgeons must decide whether a biopsy is warranted. To determine the best approach to these cases, we evaluated the clinicopathological findings for patients with unknown spinal cord lesions who underwent spinal cord biopsies.METHODS: Thirty-eight consecutive patients who underwent spinal cord biopsies at the Mayo Clinic (Rochester, MN) between August 1988 and July 1998 were studied. A detailed review of the case histories, radiological results, surgical notes, histological findings, and outcomes was performed.RESULTS: Spinal cord biopsies were performed for 21 male and 17 female patients (mean age, 42.1 yr) with progressive neurological deficits related to spinal cord lesions. All patients underwent preoperative magnetic resonance imaging evaluations. High T2-weighted signal intensity and spinal cord expansion were identified in 92 and 87% of cases, respectively. After gadolinium infusion, the majority (94%) of the inflammatory lesions demonstrated patchy and often peripherally situated enhancement. This neuroradiological pattern was less common for neoplasms (50%) and benign lesions (40%). The most common pathological findings were inflammatory changes of demyelination or sarcoidosis, which together accounted for 13 cases (34%). Nonspecific changes or benign lesions were observed in 10 cases (26%). Neoplasms were identified in eight cases (21%). One case of tuberculosis and one of schistosomiasis were found. Overall, 47% of the preoperative diagnoses made by the attending surgeon were correct. For 26% of the patients, specific treatment was based on the biopsy results. The average follow-up period was 12 months (standard deviation, 14 mo; range, 0-50 mo).CONCLUSION: Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.