Complications in 622 cases of frame-based stereotactic biopsy, a decreasing procedure
Complications in 622 cases of frame-based stereotactic biopsy, a decreasing procedure
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DOI：
10.1017/s0317167100007605
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发表时间：
2008-03-01
影响因子：
3
通讯作者：
Bernstein, Mark
中科院分区：
文献类型：
--
作者：
Kongkham, Paul N.;Knifed, Eva;Bernstein, Mark
背景资料：在过去的三十年里，基于框架的立体定向脑活检在疑似肿瘤性颅内病变患者的治疗中发挥了重要作用。我们回顾了一位外科医生的手术经验，以确定与该手术相关的并发症的性质和频率。方法：回顾性分析1986年1月至2006年5月期间接受基于框架的立体定向手术的858例患者的记录。每个病例的数据由资深作者前瞻性收集。排除了Ommaya储液囊放置、近距离放射治疗、立体定向开颅术瓣定位、分流术放置或治疗既往诊断的颅内囊性病变的手术，留下614例患者，其中共622例手术仅用于诊断目的。研究并发症发生率及其与临床变量的关系。结果：本组病例的病死率为1.3%（8/622），病死率为6.9%（43/622）。症状性出血（脑出血[ICH]、蛛网膜下腔出血[SAH]、脑室内出血[IVH]）的风险为4.8%。一过性或永久性神经功能缺损的风险分别为2.9%（18/622）和1.5%（9/622）。深部病变活检与总体并发症发生率增加相关，而多形性胶质母细胞瘤（GBM）活检与围手术期死亡率相关。结论：总的来说，并发症发生率与以前的报告相当。与接受基于框架的立体定向脑活检的其他患者相比，深部病变或组织学诊断为GBM的患者亚组可能分别具有总体并发症或死亡率升高的风险。
Background: Frame-based stereotactic brain biopsy has played an important role in the management of patients with suspected neoplastic intracranial lesions over the last three decades. We reviewed the surgical experience of one surgeon to determine the nature and frequency of complications associated with this procedure. Methods: Records were reviewed for 858 patients undergoing frame-based stereotactic procedures from January 1986 to May 2006. Data on each case were prospectively collected by the senior author. Procedures for Ommaya reservoir placement, brachytherapy, stereotactic craniotomy flap localization, shunt placement, or treatment of previously-diagnosed intracranial cystic lesions were excluded, leaving 614 patients in whom a total of 622 procedures were performed for purely diagnostic purposes. Complication rates and their association with clinical variables were sought. Results: Morbidity and mortality rates were 6.9% (43/622) and 1.3% (8/622), respectively. The risk of symptomatic hemorrhage (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], intraventricular hemorrhage [IVH]) was 4.8%. The risks of transient or permanent neurological deficits were 2.9% (18/622) and 1.5% (9/622), respectively. Biopsy of deep-seated lesions was associated with increased overall complication rate, while biopsy of Glioblastoma Multiforme (GBM) was associated with perioperative mortality. Conclusions: Overall, complication rates were comparable with those in previous reports. The subgroup of patients with deep-seated lesions or a histologic diagnosis of GBM may possess an elevated risk of overall complications or mortality, respectively, compared to other patients undergoing frame-based stereotactic brain biopsy.