框架立体定向活检术在鞍上池小体积实性肿瘤诊断中的应用价值  

Frame-based stereotactic biopsy in diagnosis of small solid tumor in the suprasellar region

作　　者：吴陈兴[1] 刘锐 钟帅 段磊 李守巍[1] Wu Chenxing;Liu Rui;Zhong Shuai;Duan Lei;Li Shouwei(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093

出　　处：《中华神经医学杂志》2021年第9期902-906,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨框架立体定向活检术在鞍上池小体积实性肿瘤中的诊断价值。方法选择自2018年4月至2020年12月首都医科大学三博脑科医院神经外科拟诊为鞍上池实体肿瘤的42例患者进入研究,所有患者均在多模态影像引导下进行框架立体定向活检手术,分析患者影像学特征及组织学病理确诊率、活检手术并发症发生情况。结果(1)患者CT图像上鞍上池病灶呈团块状,边界较清楚,其中41例患者CT呈高/稍高密度,1例钙化。MRI图像上病变亦呈团块状,信号均匀,增强影像中3例见"椒盐征",2例MRS像出现典型粗大乳酸峰。(2)42例患者均顺利实施框架立体定向活检手术,35例(83.3%)患者病理诊断明确,其中24例为生殖细胞瘤,1例为胚胎癌,6例为朗格汉斯组织细胞增生症,2例为毛细胞星形细胞瘤,2例为弥漫大B细胞淋巴瘤。术后头颅CT示术区微量出血2例,余未见出血征象。患者术前、术后临床表现未见明显变化。结论框架立体定向活检手术具有微创安全、确诊率较高等优点,在鞍上池小体积实体肿瘤的精准诊断中具有较高的应用价值。Objective To investigate the diagnostic value of frame stereotactic biopsy in patients with small solid tumors in the suprasellar region.Methods From April 2018 to December 2020,42 patients with solid tumors in the suprasellar region were selected in our hospital.All patients underwent frame stereotactic biopsy under multimodal image guidance.The imaging characteristics,histological and pathological diagnosis rate,and incidence of biopsy complications of these patients were analyzed Results(1)CT examination showed that the suprasellar cistern lesions were lumpy and well defined;41 had high/slightly high density and 1 had calcification.MRI examination showed that the lesions were also lumpy and the signal was relatively uniform;enhanced images showed that 3 patients had"salt and pepper sign";Magnetic Resonance Spectrum showed that 2 had typical huge Lip composite peak.(2)All 42 patients underwent frame stereotactic biopsy successfully,and 35 patients(83.3%)were pathologically diagnosed,including 24 with germinoma(GE),one with embryonal carcinoma,6 with Langerhans histiocytosis(LCH),2 with hair-cell astrocytoma,and 2 with diffuse large B-cell lymphoma.Postoperative head CT showed that two were with micro-hemorrhage in the operation area,and the rest showed no signs of hemorrhage.No significant changes were observed in the clinical manifestations before and after surgery.Conclusion Frame-based stereotactic biopsy is safe and reliable,with few surgical complications and high diagnosis rate in small solid tumors in the suprasellar region.

关 键 词：立体定向活检 鞍上池 生殖细胞瘤 

分 类 号：R739.41[医药卫生—肿瘤]