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Evaluación basada en vóxeles del riesgo de hemorragia en biopsias cerebrales
Mykola Gorbachuk1, Aldo Spolaore1, Eliane Weinbrenner1
1Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany.
Neurosurgical review
|January 29, 2026
Resumen
Las biopsias cerebrales conllevan riesgo de hemorragia, pero los resultados graves son infrecuentes. La focalización en lesiones cerebrales profundas, especialmente en los ganglios basales, aumenta el riesgo de hemorragia y déficits neurológicos potenciales.
Área de la Ciencia:
- Neurocirugía; Radiología; Neurología
Sus antecedentes:
- Las biopsias cerebrales estereotácticas (BB) buscan la precisión pero conllevan un riesgo de hemorragia relacionada con la biopsia (BBH).
- Comprender los factores de riesgo y la distribución espacial de la BBH es crucial para mejorar la seguridad del paciente.
Objetivo del estudio:
- Identificar los predictores de hemorragia relacionada con la biopsia (BBH) en biopsias cerebrales estereotácticas (BB).
- Analizar la distribución espacial de la BBH utilizando el mapeo de síntomas de lesiones basado en vóxeles (VLSM).
- Correlacionar la ubicación de la BBH con los resultados funcionales y el deterioro neurológico.
Principales métodos:
- Análisis de 450 biopsias cerebrales (BB) basadas en marco y asistidas por robot.
- Registro y normalización de imágenes de RM preoperatorias y TC posoperatorias al espacio MNI.
- Análisis volumétrico de BBH, regresión logística para la identificación de predictores y VLSM para el análisis espacial.
Principales resultados:
- La hemorragia ocurrió en el 18 % de las BB (80/450 casos), con BBH sintomática en el 4 % (19/450).; El glioma de alto grado, la edad del paciente y la ubicación del objetivo (ganglios basales, ínsula, cápsula interna) fueron predictores significativos de BBH.; El VLSM identificó trayectorias frontales y lesiones profundas en los ganglios basales como áreas de alto riesgo para BBH y deterioro neurológico.
Conclusiones:
- Las hemorragias asintomáticas son comunes después de las biopsias cerebrales, pero el deterioro neurológico significativo es raro.
- El riesgo de BBH es multifactorial, influenciado por las características de la lesión, los factores del paciente y la planificación de la trayectoria.
- La focalización en lesiones de los ganglios basales aumenta el riesgo de hemorragia sintomática y posibles déficits neurológicos.
Palabras clave:
cirugía estereotáctica sin marcohemorragiacirugía asistida por robotbiopsia cerebral estereotácticaestereotaxiaMás Videos Relacionados
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