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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pese a los avances de la neurorradiolog&#237;a&#44; el manejo preciso de ciertos enfermos con procesos expansivos intracraneales depende con frecuencia del conocimiento de su diagn&#243;stico histol&#243;gico&#46; En el presente trabajo&#44; se analiza el empleo de las t&#233;cnicas estereot&#225;xicas en el diagn&#243;stico y tratamiento de 174 pacientes con este tipo de patolog&#237;a&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El criterio de selecci&#243;n fue valorado mediante los datos de la historia cl&#237;nica&#44; exploraci&#243;n neurol&#243;gica&#44; estudios neurorradiol&#243;gicos y&#44; en el caso de los candidatos a cirug&#237;a&#44; se consider&#243; su riesgo vital y funcional&#46; En todos los pacientes fue realizada una biopsia estereot&#225;xica&#46; En el 85&#44;06&#37; de los enfermos fue suficiente un blanco&#44; obteni&#233;ndose un diagn&#243;stico histol&#243;gico positivo en el 92&#44;53&#37; de los casos&#46; En 44&#44; la t&#233;cnica estereot&#225;xica sirvi&#243; no s&#243;lo para obtener un diagn&#243;stico citol&#243;gico&#44; sino tambi&#233;n para vaciar una cavidad qu&#237;stica &#40;tumoral o abscesificada&#41; o realizar tratamientos braquiter&#225;picos&#46; La evoluci&#243;n postbi&#243;psica de los pacientes fue excelente en 32 &#40;18&#44;39&#37;&#41; y sin cambios en 136 &#40;78&#44;16&#37;&#41; de los casos&#46; Uno de los pacientes muri&#243;&#44; lo que corresponde a una mortalidad del 0&#44;57&#37;&#46; La morbilidad transitoria fue del 2&#44;87&#37; &#40;5 casos&#41;&#46; No hemos tenido morbilidad permanente&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Para determinar la eficacia de la metodolog&#237;a estereot&#225;xica&#44; se evalu&#243; la relaci&#243;n entre nuestros diagn&#243;sticos de presunci&#243;n y los resultados histol&#243;gicos comprobados en 149 casos&#46; S&#243;lo el 58&#44;39&#37; fue diagnosticado correctamente antes de la biopsia&#46; En otro 12&#44;75&#37; hubo diferencias en cuanto al grado de anaplasia tumoral y en el 28&#44;86&#37; restante los diagn&#243;sticos fueron incorrectos&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La angiograf&#237;a nos ha sido muy &#250;til para localizar el blanco y para evitar la hemorragia intraoperatoria&#46; La monitorizaci&#243;n de la impedancia tisular ha facilitado una informaci&#243;n importante sobre el trayecto y situaci&#243;n de la aguja&#44; de acuerdo con la residencia tisular encontrada y los cortes del TAC&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En nuestra experiencia&#44; las t&#233;cnicas estereot&#225;xicas representan un camino racional para obtener diagn&#243;sticos m&#225;s precisos y una alternativa para evitar el manejo a ciegas de una parte importante de la patolog&#237;a intracraneal&#46;</p>"
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        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The management of certain intracranial processes still depends upon a histological diagnosis despite advances in neuroradiology&#46; We analyzed the usefulness of the stereotactic technique in the diagnosis and treatment of 174 patients harbouring intracranial processes&#46; The selection criteria was evaluated by history&#44; neurological examination&#44; neuroradiological studies&#44; and in the case of surgical candidates&#44; by their vital and functional risks&#46; In all our patients a stereotactic biopsy was performed&#46; One target was enough in 85&#44;06&#37;&#44; and a positive histological diagnosis was obtained in 92&#44;53&#37;&#46; In 44 out of our 174 cases the stereotactic system was used not only to obtain a cytological diagnosis but also to deflate a cyst cavity &#40;tumoral or abscess&#41; or to insert or remove a radioactive isotope&#46; The patient&#39;s postbiopsy course was excellent in 32 &#40;18&#44;39&#37;&#41; and unchanged in 136 &#40;78&#44;16&#37;&#41;&#46; One patient died&#44; which corresponds to a mortality rate of 0&#44;57&#37;&#46; The transitory morbidity was 2&#44;87&#37; &#40;5 cases&#41;&#46; No permanent morbidity was noted&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the efficiency of our stereotactic methodology we evaluated the relationship between our presumptive diagnosis from the cl&#237;nical and neuroradiological studies and the final histological results&#46; The presumptive diagnosis was confirmed in 58&#44;39&#37;&#44; in 12&#44;75&#37; the differences were in the degree of tumor anaplasia and in 28&#44;86&#37; our diagnosis was incorrect&#46; Angiography was considered very useful in localizing the target and in avoiding intraoperative haemorrhage&#46; Impedance monitoring gave us important information regarding the trajectory and depth of the target according to the tissue resistance encountered&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From our experience&#44; we think that stereotactic techniques represent an alternative to blind management of an important part of intracranial pathology&#44; and a rational way to obtain a more accurate diagnosis&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Hern&#225;ndez Vicente J&#46;&#59; Morales Ramos F&#46;&#59; Santos Briz A&#46;&#59; Maillo S&#225;nchez A&#46;&#59; G&#243;mez-Moreta J&#46; A&#46;&#59; D&#237;az Cascajo P&#46;&#58; Empleo de la biopsia estereot&#225;xica en pacientes con procesos expansivos intracraneales&#46; Neurocirug&#237;a&#44; 1991&#59; 2&#58; 87&#8211;94&#46;</p>"
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Vol. 2. Núm. 2.
Páginas 87-94 (enero 1991)
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Vol. 2. Núm. 2.
Páginas 87-94 (enero 1991)
Empleo de la biopsia estereotáxica en pacientes con procesos expansivos intracraneales
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J. Hernández Vicente, F. Morales Ramos, A. Maillo Sánchez, J.A. Gómez-Moreta, P. Díaz Cascajo
Servicios de Neurocirugía. Hospital Virgen de la Vega
A. Santos Briz*
* Servicios de Anatomía Patológica. Hospital Virgen de la Vega
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Resumen

Pese a los avances de la neurorradiología, el manejo preciso de ciertos enfermos con procesos expansivos intracraneales depende con frecuencia del conocimiento de su diagnóstico histológico. En el presente trabajo, se analiza el empleo de las técnicas estereotáxicas en el diagnóstico y tratamiento de 174 pacientes con este tipo de patología.

El criterio de selección fue valorado mediante los datos de la historia clínica, exploración neurológica, estudios neurorradiológicos y, en el caso de los candidatos a cirugía, se consideró su riesgo vital y funcional. En todos los pacientes fue realizada una biopsia estereotáxica. En el 85,06% de los enfermos fue suficiente un blanco, obteniéndose un diagnóstico histológico positivo en el 92,53% de los casos. En 44, la técnica estereotáxica sirvió no sólo para obtener un diagnóstico citológico, sino también para vaciar una cavidad quística (tumoral o abscesificada) o realizar tratamientos braquiterápicos. La evolución postbiópsica de los pacientes fue excelente en 32 (18,39%) y sin cambios en 136 (78,16%) de los casos. Uno de los pacientes murió, lo que corresponde a una mortalidad del 0,57%. La morbilidad transitoria fue del 2,87% (5 casos). No hemos tenido morbilidad permanente.

Para determinar la eficacia de la metodología estereotáxica, se evaluó la relación entre nuestros diagnósticos de presunción y los resultados histológicos comprobados en 149 casos. Sólo el 58,39% fue diagnosticado correctamente antes de la biopsia. En otro 12,75% hubo diferencias en cuanto al grado de anaplasia tumoral y en el 28,86% restante los diagnósticos fueron incorrectos.

La angiografía nos ha sido muy útil para localizar el blanco y para evitar la hemorragia intraoperatoria. La monitorización de la impedancia tisular ha facilitado una información importante sobre el trayecto y situación de la aguja, de acuerdo con la residencia tisular encontrada y los cortes del TAC.

En nuestra experiencia, las técnicas estereotáxicas representan un camino racional para obtener diagnósticos más precisos y una alternativa para evitar el manejo a ciegas de una parte importante de la patología intracraneal.

Palabras clave:
Biopsia cerebral
Neoplasia cerebral
Manejo de los gliomas
Cirugía estereotáxica
Summary

The management of certain intracranial processes still depends upon a histological diagnosis despite advances in neuroradiology. We analyzed the usefulness of the stereotactic technique in the diagnosis and treatment of 174 patients harbouring intracranial processes. The selection criteria was evaluated by history, neurological examination, neuroradiological studies, and in the case of surgical candidates, by their vital and functional risks. In all our patients a stereotactic biopsy was performed. One target was enough in 85,06%, and a positive histological diagnosis was obtained in 92,53%. In 44 out of our 174 cases the stereotactic system was used not only to obtain a cytological diagnosis but also to deflate a cyst cavity (tumoral or abscess) or to insert or remove a radioactive isotope. The patient's postbiopsy course was excellent in 32 (18,39%) and unchanged in 136 (78,16%). One patient died, which corresponds to a mortality rate of 0,57%. The transitory morbidity was 2,87% (5 cases). No permanent morbidity was noted.

To determine the efficiency of our stereotactic methodology we evaluated the relationship between our presumptive diagnosis from the clínical and neuroradiological studies and the final histological results. The presumptive diagnosis was confirmed in 58,39%, in 12,75% the differences were in the degree of tumor anaplasia and in 28,86% our diagnosis was incorrect. Angiography was considered very useful in localizing the target and in avoiding intraoperative haemorrhage. Impedance monitoring gave us important information regarding the trajectory and depth of the target according to the tissue resistance encountered.

From our experience, we think that stereotactic techniques represent an alternative to blind management of an important part of intracranial pathology, and a rational way to obtain a more accurate diagnosis.

Key words:
Brain biopsy
Brain neoplasm
Glioma management
Stereotactic surgery

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