Frameless stereotactic biopsy for precision neurosurgery: diagnostic value, safety, and accuracy
Frameless stereotactic biopsy for precision neurosurgery: diagnostic value, safety, and accuracy
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DOI：
10.1007/s00701-019-03873-w
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发表时间：
2019-05-01
影响因子：
2.4
通讯作者：
Riva, Marco
中科院分区：
文献类型：
--
作者：
Sciortino, Tommaso;Fernandes, Bethania;Riva, Marco
背景 立体定向活检一直用于表征不适合显微手术切除的患者的脑病变。在过去的几年中，技术进步和神经影像学进步有助于提高诊断率、安全性和该程序的应用。目前，除了组织学诊断之外，分子分析被认为在诊断过程中至关重要，以便以个性化方法正确选择治疗和预后算法。本研究报告了我们在这个分子时代进行无框架立体定向脑活检的经验。方法对2013年1月至2018年9月连续治疗的140名患者进行了分析。使用 Brainlab Varioguide (R) 无框架立体定向系统进行活检。记录并评估患者的临床和人口统计数据、手术室占用时间、手术时间、发病率以及提供组织学和分子诊断的诊断率。结果总体诊断率为 93.6%，其中 9 例手术无法诊断。在 110 名神经胶质瘤患者中，108 例 (98.2%) 存在 IDH-1 突变状态，除 3 例外，所有受试者均为野生型； MGMT 甲基化在 96 例 (87.3%) 中进行了表征，结果出现在 60 名患者中，在分析的 20 例 II-III 级神经胶质瘤中，有 6 例发现了 1p/19q 联合缺失。所有样本在进行时都适合进行分子分析。 2.1%的病例发生需要手术引流的出血；观察到 8 例（5.7%）无症状出血，无需治疗。没有记录与活检相关的死亡率。中位住院时间为 5 天 (IQR 4-8)，平均手术时间为 60.77 分钟 (23.12)，手术室总占用时间为 137.44 +/- 24.1 分钟。 结论 立体定向无框活检是一种安全、可行、快速的获得组织学和分子诊断的方法。
BackgroundStereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach. The present study reports our experience with frameless stereotactic brain biopsy in this molecular era.MethodsOne hundred forty consecutive patients treated from January 2013 to September 2018 were analyzed. Biopsies were performed using the Brainlab Varioguide (R) frameless stereotactic system. Patients' clinical and demographic data, the time of occupation of the operating room, the surgical time, the morbidity, and the diagnostic yield in providing a histological and molecular diagnosis were recorded and evaluated.ResultsThe overall diagnostic yield was 93.6% with nine procedures resulting non-diagnostic. Among 110 patients with glioma, the IDH-1 mutational status was characterized in 108 cases (98.2%), resulting wild-type in all subjects but 3; MGMT methylation was characterized in 96 cases (87.3%), resulting present in 60 patients, and 1p/19q codeletion was founded in 6 of the 20 cases of grade II-III gliomas analyzed. All the specimens were apt for molecular analysis when performed. Bleeding requiring surgical drainage occurred in 2.1% of the cases; 8 (5.7%) asymptomatic hemorrhages requiring no treatment were observed. No biopsy-related mortality was recorded. Median length of hospital stay was 5days (IQR 4-8) with mean surgical time of 60.77min (23.12) and 137.44 +/- 24.1min of total occupation time of the operative room.Conclusions Stereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.