Stereotactic biopsy for lesions in brainstem and deep brain: a single-center experience of 72 cases

Stereotactic biopsies for lesions in the brainstem and deep brain are rare. This study aimed to summarize our 6-year experience in the accurate diagnosis of lesions in the brain stem and deep brain and to discuss the technical note and strategies. From December 2011 to January 2018, 72 cases of intracranial lesions in the brainstem or deep in the lobes undergoing stereotactic biopsy were retrospectively reviewed. An individualized puncture path was designed based on the lesion's location and the image characteristics. The most common biopsy targets were deep in the lobes (43 cases, 59.7%), including frontal lobe (33 cases, 45.8%), temporal lobe (4 cases, 5.6%), parietal lobe (3 cases, 4.2%), and occipital lobe (3 cases, 4.2 %). There were 12 cases (16.7%) of the brainstem, including 8 cases (11.1%) of midbrain, and 4 cases (5.6%) of pons or brachium pontis. Other targets included internal capsule (2 cases, 2.8%), thalamus (3 cases, 4.2%), and basal ganglion (12 cases, 16.7%). As for complications, one patient developed acute intracerebral hemorrhage in the biopsy area at 2 h post-operation, and one patient had delayed intracerebral hemorrhage at 7 days post-operation. The remaining patients recovered well after surgery. There was no surgery-related death. The CT-MRI-guided stereotactic biopsy of lesions in the brainstem or deep in the brain has the advantages of high safety, accurate diagnosis, and low incidence of complications. It plays a crucial role in the diagnosis of atypical, microscopic, diffuse, multiple, and refractory lesions.

针对脑干及脑深部病变的立体定向活检术较为罕见。本研究旨在总结本中心6年间针对脑干及脑深部病变的精准诊断经验，并探讨相关技术要点与实施策略。本研究回顾性分析了2011年12月至2018年1月期间，72例接受立体定向活检的颅内脑干病变或脑深部脑叶病变患者的临床资料。研究团队根据病变位置与影像特征，为每位患者设计个体化穿刺路径。活检靶点最常见为脑深部脑叶（43例，占比59.7%），其中额叶33例（45.8%）、颞叶4例（5.6%）、顶叶3例（4.2%）及枕叶3例（4.2%）。脑干病变共12例（16.7%），其中中脑8例（11.1%），脑桥或脑桥臂4例（5.6%）。其他活检靶点包括内囊2例（2.8%）、丘脑3例（4.2%）及基底节12例（16.7%）。并发症方面，1例患者于术后2小时出现活检区域急性脑内出血，1例患者于术后7天出现迟发性脑内出血；其余患者术后均顺利恢复，无手术相关死亡病例。CT-MRI引导下的脑干及脑深部病变立体定向活检术具有安全性高、诊断精准、并发症发生率低的优势，在非典型、隐匿性、弥漫性、多发性及难治性病变的诊断中具有关键价值。