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Background. The goal of the current study was to assess the usefulness, reliability and safety of the image guided stereotactic biopsy of intra-axial brain tumours. Methods. The study was conducted within a time frame of one year. 20 patients - 14 males and 6 females (median age 63.5 years) were included. Computerized tomography (CT) - guided stereotactic biopsies were performed by a single stereotactic neurosurgeon. A modified Riechert Stereotactic System (MHT Medical High Tech) and a workstation for multiplanar trajectory planning (Amira) were used. Biopsies were done with small forceps and 10-15 samples were collected for histological analysis. During the operations also touch imprints and crush smears of the specimens were examined by the cytopathologist. Correct place of the biopsy and any detectable bleeding were analyzed by post-op CT scan. Descriptive statistic methods were used and results were compared with the data from the literature. Results. Overall treatment morbidity was limited to one patient (5 %), there was no mortality. A conclusive tissue diagnosis could be achieved in 19 out of 20 patients (95 %). There were 3 glioblastomas, 3 anaplastic astrocitomas, 5 astrocitomas, 1 inflammation, 2 lymphomas, and 2 malignant tumours - not further classified and 3 metastasis. All patients had post biopsy CT scan to check for haemorrhage (none occurred). Conclusions MHT Stereotactic system and Amira multiplanar image guided trajectory planning software are reliable tools enabling trained stereotactic neurosurgeon to obtain tissue diagnosis in almost every case with very little morbidity. Izhodišča. Cilj raziskave je bil oceniti uporabnost, zanesljivost in varnost s CT vodene stereotaktične biopsije intrinzičnih možganskih tumorjev. Metode. V obdobju enega leta smo operirali 20 bolnikov, 14 moških in 6 žensk, mediana starost 63,5 leta. Pri vseh smo opravili računalniško tomografsko (CT) vodeno stereotaktično biopsijo. Uporabili smo modificirani Riechertov (MHT Medical High Tech) stereotaktični sistem in računalniški program Amira, s katerim smo lahko načrtovali trajektorij v treh ravninah. Vzorce smo odvzemali z biopsijskimi kleščami. Odvzeli smo 10-15 vzorcev za histološko analizo. Med operacijo je odtise in razmaze vzorcev pregledala citopatologinja. Mesto biopsije in morebitno prisotnost krvavitve smo analizirali s pooperativno CT-preiskavo. Rezultate smo analizirali z deskriptivno statistično metodo in rezultate primerjali s podatki iz literature. Rezultati. Celokupna obolevnost v povezavi s posegom je bila 5 % (1 od 20 bolnikov), umrlih ni bilo. Histološko diagnozo smo uspeli postaviti pri 19 od 20 bolnikov (95 %). Našli smo 3 glioblastome, 3 anaplastične astrocitome, 5 astrocitomov, 2 maligna tumorja brez druge opredelitve, 1 vnetje, 2 limfoma, 3 metastaze. Vsi bolniki so v prvih 24 urah po biopsiji opravili kontrolni CT, ki je pri vseh izključil krvavitev. Zaključki. MHT stereotaktični okvir in računalniški program Amira, ki omogoča načrtovanje v treh ravninah, sta zanesljivo orodje, ki v izkušenih rokah omogočata natančno in varno diagnozo globokih možganskih sprememb z majhno obolevnostjo. |
