gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Stereotactic approach to brain stem lesions: high risk?

Stereotaktische Biopsien bei Hirnstammläsionen

Meeting Abstract

  • corresponding author E. E. Gehrke - Abt. Stereotaktische Neurochirurgie, Albert-Ludwigs-Universität Freiburg
  • M. Trippel - Abt. Stereotaktische Neurochirurgie, Albert-Ludwigs-Universität Freiburg
  • J. Vesper - Abt. Stereotaktische Neurochirurgie, Albert-Ludwigs-Universität Freiburg
  • G. Nikkhah - Abt. Stereotaktische Neurochirurgie, Albert-Ludwigs-Universität Freiburg
  • C. Ostertag - Abt. Stereotaktische Neurochirurgie, Albert-Ludwigs-Universität Freiburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-17.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0083.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Gehrke et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Differential diagnosis and therapeutic strategies for brain stem lesions provide a considerable challenge for an optimal neurosurgical management. A clear histopathological diagnosis is mandatory and can be achieved by the minimal invasive stereotactic approach, and, in some cases, even combined with therapeutic intervention.

Methods

The medical records of 101 patients, who underwent stereotactic neurosurgical procedures (biopsies, seed-implantations, evacuations of cystic formations) of brainstem lesions over the last 5-year period were reviewed. Stereotactic planning was performed with CT- and MRI-image-fusion. The majority of stereotactic procedures were done under local anesthesia (114/142). The remaining 28 patients (all children) were operated under general anesthesia.

Results

Analysis of the 101 patients revealed the following characteristics: female/male ratio 47/54, age 0-79 yrs., 33 (33%) patients of age 18 yrs. and younger. We performed 142 stereotactic procedures, i.e. 106 biopsies, 12 seed implantations, 21 evacuation of brain stem cysts and two Rickham-catheter implantations (0.5% from a total of 2702 stereotactic procedures between 1999 – 2004). In almost all cases the trajectory was planned via a frontal precoronal approach (96%, n=136), in 6 cases a suboccipital trajectory was chosen. A morbidity of 3% (3 cases with transient neurological symptoms) and no perioperative mortality was observed. Morbidity was caused by volume reduction in a brain stem cyst (1) and two small intracerebral hematomas (2) along the trajectory which resolved in both cases spontaneously concomitant with clinical improvement. Pathological diagnosis could be obtained in 96% of the patients (n=97): 29 low-grade astrocytomas, 31 high-grade astrocytomas, 10 metastases, 9 inflammatory lesions, 4 primary CNS-lymphomas, 4 primitive neuroectodermal tumors (PNET), 2 cases of gliosis, 2 intracerebral abscesses, 2 vascular malformations, 1 medulloblastoma, 1 ependymoma, 1 plexuspapilloma, 1 diffuse myelitis.

Conclusions

Brain stem lesions are composed of a wide variety of different neuropathological entities that can be diagnosed, and in some cases, effectively treated by stereotactic neurosurgical procedures with minimal morbidity and low risk.