在立体定向脑穿刺活检中,比较麻花钻与毛刺孔开颅术的诊断率、手术时间和术后出血情况。

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Rahul Kumar, Michelle W McQuinn, Alexander B Pais, Kai J Miller, Terry C Burns, Lucas P Carlstrom
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引用次数: 0

摘要

立体定向无框架针式脑活检是一种常见的神经外科手术,通过扭转钻孔或开放式毛刺孔方法进行。我们旨在比较诊断结果和手术效果,以确定两种方法的安全性和有效性。我们建立了一个回顾性数据库,收集了一家医疗机构在 30 个月内进行的所有立体定向穿刺活检手术。研究人员对患者的人口统计学特征、合并症、手术细节/并发症、术后即时影像学检查和病理学检查进行了摘录。共确定了 225 例针活检,其中 165 例(73.3%)为开放活检,60 例(26.7%)为扭钻活检。开放式(84.8%)和扭钻式(93.3%)两种方法的病理诊断率相似(p = 0.15),每种方法取芯的中位数均为 4 个(p = 0.30)。术中暂停进行病理确认的诊断组织率为 90.4%,而未暂停的诊断组织率为 79.1%(p = 0.036,OR 2.49)。开腹手术与扭钻手术的中位手术时间分别为 68.0 分钟(IQR 49-83 分钟)和 35.5 分钟(IQR 26-54 分钟)(Wilcoxon p = 0.036,OR 2.49)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of diagnostic yields, operative times, and post-operative hemorrhage between twist drill versus burr hole craniotomy approaches for stereotactic needle brain biopsy.

Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0 min (IQR 49-83) versus 35.5 min (IQR 26-54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique.

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来源期刊
Neurosurgical Review
Neurosurgical Review 医学-临床神经学
CiteScore
5.60
自引率
7.10%
发文量
191
审稿时长
6-12 weeks
期刊介绍: The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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