立体定向活检诊断颅内多发性胶质瘤
摘要
颅内多发性胶质瘤在临床上比较少见,在诊断上与多发性脑转移瘤、多发脑脓肿等很多疾病很难鉴别,最后确诊还要依赖组织病理学结果。立体定向活检为颅内多发性胶质瘤的诊断提供了重要的诊断方法。我们从经CT或MRI引导下行立体定向活检1049例患者中,选取病理结果为颅内多发性胶质瘤的17例患者。17例患者都得出了明确的阳性病理诊断。其中:星形细胞瘤Ⅰ级1例,星形细胞瘤Ⅰ-Ⅱ级1例,星形细胞瘤Ⅱ级5例,星形细胞瘤Ⅱ-Ⅲ级4例,星形细胞瘤Ⅲ级2例,少突胶质细胞瘤1例,多形性胶质母细胞瘤1例,胶质母细胞瘤4例。其中多灶性脑胶质瘤15例,多中心性脑胶质瘤2例。全组17例患者中,13例患者在手术中或术后给予相应的治疗,其中~(125)Ⅰ籽粒植入治疗9例;伽玛刀放射治疗2例;全脑放疗结合化疗1例;化疗1例,放弃治疗4例。全组17例患者总体平均生存期为7个月(2-18个月),其中生存期3个月以下的1例;生存期3-6个月以下的5例;生存期6-12个月的8例;生存期12个月以上的3例。其中多灶性脑胶质瘤平均生存期为7.9个月,多中心性脑胶质瘤平均生存期为3.5个月。结合本组临床数据总结和以往文献报道得出以下结论:立体定向活检是脑深部占位性病变定性诊断的重要手段;立体定向活检是确定复杂颅内病变,如颅内多发性胶质瘤病理诊断的必要方法;颅内多发性胶质瘤常见于中老年人;影响学上以长T1、长T2为主,增强后强化明显,占位效应明显;预后较差,平均生存期为7个月。
Objective:Multiple gliomas are not frequently seen in clinics.They could be misdiagnosed as metastatic brain tumors,multiple abscess or other cerebral diseases.A definite diagnosis of multiple gliomas should be confirmed by histopathological examination.Stereotactic biopsy represents a safe and satisfactory method for achieving sure diagnosis for intracranial lesions.It has become a powerful and safe tool for providing tissue samples for diagnosis with minimal disruption of normal brain function,and plays a significant role in the diagnosis of intracranial lesions.Despite the diagnosis rate of intracranial lesions has been greatly improved with the progress of imaging technology, there are still some brain lesions particularly deep or multiple lesions can not be determined only by the combination of radio image and clinical manifestations, the definite diagnosis should be confirmed by histopathological examination. Because the clinical manifestations and radioimage features of multiple gliomas are not typical,the final diagnosis should depend on histopathological diagnosis.
In present,how to improve the diagnosis rate of multiple gliomas is a hot and difficult tissue.Despite there are some progresses concerning the classification and pathogenesis,there are seldom literatures which focus on the diagnosis of multiple gliomas.
To investigate the role of stereotactic biopsy for pathological diagnosis of multiple gliomas,meanwhile explore the clinical manifestations,diagnosis methods,therapy and prognosis of multiple gliomas.We selected patients with multiple gliomas confirmed by stereotactic biopsy by screening the data of 1039 patients diagnosed by stereotactic biopsy in The Navy General Hospital of PLA from 1988 to 2007 and 10 patients diagnosed by stereotactic Clinical in Chinese-Japan Union Hospital of Jilin University from January 2005 to December 2007.17 cases have been choosed.And clinical data of the 16 cases are analyzed retrospectively.
Methods:All the 17 cases were underwent CT/MRI-guided stereotactic biopsies.All the procedures were done under local anesthesia with CT or MRI guided stereotactic system.The "four point-one line" hand count method and Computer-assisted Planning for Neurosurgery was used to determine the coordinate.The specimens obtained from stereotactic biopsy were underwent pathological exam.Of the 17 cases,one target was selected in 13 cases,and two targets were selected in other 4 cases.
Results:Thus far,in foreign literature,there were 3 papers having reporting 18 cases with multiple gliomas diagnosed by stereotactic biopsy;In Chinese literature,there were 5 papers having reporting 25 cases.In our study, 17 cases with multiple gliomas were diagnosed by CT or MRI guided stereotactic biopsy.Of the 17 cases,11 were male and 6 were female.The ratio of male to female was 1.8:1.Age at presentation of GC ranged from 30 years to 75 years(.median,49.2 years).Main symptoms:headache(9 cases),epilepsy(7 cases),limb weakness(6 cases),with two cases of disturbance of consciousness. Finding on neurological examination included pyramidal tract impairment(10 cases),the reaction retardation or dementia(2 cases),decreased visual acuity(1 cases),and visual field defect(1 cases).Of the 17 cases,there were 12 cases of astrocytoma(WHO I,1 cases;WHOⅠ-Ⅱ,1 cases;WHOⅡ,5 cases; WHOⅡ-Ⅲ,4 cases;WHOⅡ-Ⅲ,4 cases;WHOⅢ,2 cases),1 case of anaplastic oligodendroglioma and 4 cases of glioblastoma.The median survival is 7months(range from 2 months to 18 months).There are 15 cases of multifocal gliomas,and 2 cases of multicentric gliomas.In patients with multifocal gliomas,the median survival of is 7.9 months.In patients with multicentric gliomas,the median survival of is 3.5 months.
Conclusions:
1.Stereotactic biopsy is a powerful and safe tool to provide tissue diagnosis for deep brain lesions.
2.Stereotactic biopsy represents a safe and reliable method for histological diagnosis of multiple gliomas.
3.In our study,the majority of patients with multiple gliomas are of old age.Generally,lesions produce a hypointense signal on T1-weighted images, and a hyperintense signal with T2-weighted images.Edema and mass effects are moderate.Contrast enhancement is most strong.The prognosis is grim,and the median survival is 7months.
Objective:Multiple gliomas are not frequently seen in clinics.They could be misdiagnosed as metastatic brain tumors,multiple abscess or other cerebral diseases.A definite diagnosis of multiple gliomas should be confirmed by histopathological examination.Stereotactic biopsy represents a safe and satisfactory method for achieving sure diagnosis for intracranial lesions.It has become a powerful and safe tool for providing tissue samples for diagnosis with minimal disruption of normal brain function,and plays a significant role in the diagnosis of intracranial lesions.Despite the diagnosis rate of intracranial lesions has been greatly improved with the progress of imaging technology, there are still some brain lesions particularly deep or multiple lesions can not be determined only by the combination of radio image and clinical manifestations, the definite diagnosis should be confirmed by histopathological examination. Because the clinical manifestations and radioimage features of multiple gliomas are not typical,the final diagnosis should depend on histopathological diagnosis.
In present,how to improve the diagnosis rate of multiple gliomas is a hot and difficult tissue.Despite there are some progresses concerning the classification and pathogenesis,there are seldom literatures which focus on the diagnosis of multiple gliomas.
To investigate the role of stereotactic biopsy for pathological diagnosis of multiple gliomas,meanwhile explore the clinical manifestations,diagnosis methods,therapy and prognosis of multiple gliomas.We selected patients with multiple gliomas confirmed by stereotactic biopsy by screening the data of 1039 patients diagnosed by stereotactic biopsy in The Navy General Hospital of PLA from 1988 to 2007 and 10 patients diagnosed by stereotactic Clinical in Chinese-Japan Union Hospital of Jilin University from January 2005 to December 2007.17 cases have been choosed.And clinical data of the 16 cases are analyzed retrospectively.
Methods:All the 17 cases were underwent CT/MRI-guided stereotactic biopsies.All the procedures were done under local anesthesia with CT or MRI guided stereotactic system.The "four point-one line" hand count method and Computer-assisted Planning for Neurosurgery was used to determine the coordinate.The specimens obtained from stereotactic biopsy were underwent pathological exam.Of the 17 cases,one target was selected in 13 cases,and two targets were selected in other 4 cases.
Results:Thus far,in foreign literature,there were 3 papers having reporting 18 cases with multiple gliomas diagnosed by stereotactic biopsy;In Chinese literature,there were 5 papers having reporting 25 cases.In our study, 17 cases with multiple gliomas were diagnosed by CT or MRI guided stereotactic biopsy.Of the 17 cases,11 were male and 6 were female.The ratio of male to female was 1.8:1.Age at presentation of GC ranged from 30 years to 75 years(.median,49.2 years).Main symptoms:headache(9 cases),epilepsy(7 cases),limb weakness(6 cases),with two cases of disturbance of consciousness. Finding on neurological examination included pyramidal tract impairment(10 cases),the reaction retardation or dementia(2 cases),decreased visual acuity(1 cases),and visual field defect(1 cases).Of the 17 cases,there were 12 cases of astrocytoma(WHO I,1 cases;WHOⅠ-Ⅱ,1 cases;WHOⅡ,5 cases; WHOⅡ-Ⅲ,4 cases;WHOⅡ-Ⅲ,4 cases;WHOⅢ,2 cases),1 case of anaplastic oligodendroglioma and 4 cases of glioblastoma.The median survival is 7months(range from 2 months to 18 months).There are 15 cases of multifocal gliomas,and 2 cases of multicentric gliomas.In patients with multifocal gliomas,the median survival of is 7.9 months.In patients with multicentric gliomas,the median survival of is 3.5 months.
Conclusions:
1.Stereotactic biopsy is a powerful and safe tool to provide tissue diagnosis for deep brain lesions.
2.Stereotactic biopsy represents a safe and reliable method for histological diagnosis of multiple gliomas.
3.In our study,the majority of patients with multiple gliomas are of old age.Generally,lesions produce a hypointense signal on T1-weighted images, and a hyperintense signal with T2-weighted images.Edema and mass effects are moderate.Contrast enhancement is most strong.The prognosis is grim,and the median survival is 7months.
引文
1.王忠诚主编.王忠诚神经外科学.北京:湖北科学技术出版社,2005:512.
2.Djalilian HR,Shah MV,Hall WA.Radiographic incidence of multicentric malignant gliomas.Surg Neurol,1999,51:554.
3.田增民主编.现代立体定向神经外科学.第1版.北京:中国科学技术出版社,1997,114.
4.李甘地主编.病理学,第六版.北京:人民卫生出版社,2001,1-10.
5.邱胜利.立体定向颅内病灶活检术.立体定向和功能性神经外科杂志,2005.18:189-191.
6.Hall WA.The safety and efficacy of stereotactic brain biopsy for intracranial lesions.Cancer,1998,82:1769-1755.
7.Gerdes JS,Hitchin PW,Neerangun W,et al.Computed tomography versus magnetic resonance imaging in steretactic localization.Stereotact Func Neurosurg,1994,63:124-129.
8.Mundinger F.CT-stereotactic biopsy for optimizing the therapy of intracranial processes.Acta Neurochir(Suppl),1985,35:70-74.
9.Apuzzo MLJ,Chandrasoma PT,Cohen D,et al.Computed imaging stereotaxy:experience and perspective related to 500 procedures applied to brain masses.Neruosurgery,1987,20:930-937.
10.Salvati M,Caroli E,Orlando ER,et al.Multicentric gliomas:our experience in 25 patients and critical review of the literature.Neurosurg Rev 2003,26:275.
11.Lafitte E,Morel-Precetti S,Martin-uvernuil,et al,Multiple glioblastomas:CT and MR features.Eur Radiol,2001,11:131.
12.Zamponi N,Rychlicki F,Ducati A,et al.Multicentric glioma with unusual clinical presentation.Childs Nervous System,2001,17:101-105.
13.方雷,余永强,钱银锋,等.颅内多发性胶质瘤的CT与MRI特征.临床放射学杂志,2006,25:313-315.
14.田宇,艾天贻,赵兴利,等.立体定向手术中确定三维长轴和人颅点的方法-“四点一线手算法”.立体定向和功能性神经外科杂志,2007,20:48-49.
15.Rajshekhar V.Current assisted stereotactic biopsy and volumetric resection of pediatric brain tumors,Neurologic Clinics,1991;9:317-336.
16.Bhardwaj RD,Bemstein M.Prospectiva feasibility study of outpatient stereotactic brain lesion biopsy.Neumsurgery,2002,51:358-361.
17.Matthew J McGirt,Alan T Villavicencio.MRI-Guided Stereotactic Biopsy in the Djagnosis of Glloma:Comparison of Biopsy and Surgical Resection Specimen.SurgNeurol,2003,59:277-281.
18.于新,刘宗惠.微侵袭立体定向活检方法的研究.中华神经外杂志,2001,17:354-356.
19.王进刚,黄文辉,胡滨,等.立体定向脑活检术58例经验总结.中国微侵袭神经外科杂志,2004,9:462-463.
20.Landy HJ,Lee TT,Potter P,et al.Early MRI findings in high grade glioma.J Neurooncol,2000,47:65-72.
21.Gerdes JS,Hitchin PW,Neerangun W,et al.Computed tomography versus magnetic resonance imaging in steretactic localization.Stereotact Func Neurosurg,1994,63:124-129.
22.Kim Jh,Gildenberg PI.Stereotactic biopsy.In:Gilderduerg PL,Tasker RR (eds).Textbook of Stereotactic and Functional Neuresurgery.New York:Mc Graw-Hill,1998:387-396.
23.Chandrasoma PT,Smith MM,Apuzzo MLJ.Stereotactic biopsy in the diagnosis of brain masses:comparison of results of biopsy and resected surgical specimen.Neurosurgery,1989,24:160-165.
24.刘宗惠,陈琳.805例立体定向脑活检报告.中国神经精神疾病杂 志,2004,30:401-404.
25.Alesch F,Pappaterra J,Trattnig S,et al.The role of stereotactic biopsy in radiosurgery.Acts Neurochir(Suppl),1995,63:20.
26.Gonealves-Ferreira AJ,Herculano-Carvaho M.et al.Stereotactic biopsies of focal brainsten lesions.Surg Neurol,2003,60:311-320.
27.汪业汉,吴承远主编.立体定向神经外科手术学.北京:人民卫生出版社,2005:195-196.
28.李书成,刘永吉.多发性胶质瘤和多中心肿瘤.中华神经外科杂志,1988,23.
29.潘力,蒋大介,江澄川.CT立体定向脑深部病变活检术 初步报告.中国神经精神疾病杂志,1988,14:209-211.
30.刘宗惠,于新,田增民,等.CT引导立体定向脑深部病灶活检术(附241例临床分析).微侵袭神经外科杂志,1996,1:15-17.
31.董长征,赵文清,李文玲,等.立体定向活检术确诊多发性颅内胶质瘤8例.河北医药,2007,29:30-31.
32.Mishra HB,Haran JP,Singh JP,et al.Multicentric gliomas:two case reports and a review of the literature.BrJ Neurosurgery,1990,4:535-539.
33.Pell MF,Revesz T,Thomas DG.Multicentric malignant glioma.British Journal of Neurosurgery,1991,5:631-634
34.Franzini A,Leocata F,Giorgi C,et al.Role of stereo tactic biopsy in multifocal brain lesions:considerations on 100 consecutive cases.J Neurol Neurosurg Psychiatry,1994,57:957-960.
35.Zaki HS,Jenkinson MD,Du Plessis DG,et al.Vanishing contrast enhancement in malignant glioma after corticosteroid treatment.Acta Neurochir(Wien),2004,146:841-845.
36.Zamponi N,Rychlicki F,Ducati A,et al.Multicentric glioma with unusual clinical presentation.Childs Nervous System,2001,17:101-105.
37.Lafitte E,Morel-Precetti S,Martin-uvernuil,et al.Multiple glioblastomas:CT and MR features.Eur Radiol,2001,11:131.
38.Synowitz M,von Eckardstein K,Brauer C,et al.Case history:multicentric glioma with involvement of the optic chiasm.Clinical Neurology &Neurosurgery,2002,105:66-8.
39.Jomin M,Lesoin F,Lozes G,et al.Multifocal glioma.Apropos of 10 cases.Neurochirurgie,1983,29:41-6.
40.Salvati M,Cervoni L,Celli P,et al.Multicentric and multifocal primary cerebral tumors.Methods of diagnosis and treatment.Ital J Neurol Sci,1997,18:17-20.
41.Barnard RO,Geddes JF.The incidence of multifocal cerebral gliomas.A histologic study of large hemisphere sections.Cancer.1987,60:1519-31.
42.孙鹏,杨新生,孟庆海,等.颅内多发性胶质瘤(附9例报告).齐鲁医学杂志,1999,14:45-46.
43.Jelsma R,Bucy PC.The treatment of glioblastoma multiforme of the brain.J Neurosci,1967,27:338-400.
44.Marshall LF,Jennet B,Longot KW.Needle biopsy for the diagnosis of malignant gliomas.JAMA,1974,228:1417-1418.
45.Chadduck WM,Roycroft D,Brown MW.Multicentric glioma as a cause of multiple cerebral lesions.Neurosurgery,1983,13:170-175.
1.刘宗惠主编.实用立体定向及功能性神经外科学.北京:人民军医出版社,2006.1-164.
2.傅先明,牛朝诗主编.立体定向和功能性神经外科学.合肥:安徽科学技术出版社出版,2004,1-286.
3.田增民.立体定向功能神经外科的发展趋势.中华神经医学杂志,2003,2,2-5.
4.田增民.立体定向神经外科发展动向与趋势.中华神经外科疾病研究杂志,2003.2:289-292.
5.田增民主编.现代立体定向神经外科学.北京:中国科学技术出版社,1997,9-31.
6.Rajshekhar V.Gurrenl status of stereotatic biopsy.Stereotact Funct Neurosurg,2001,76:33-39.
7.Ohye C,Shibazaki T.Lesioning the thealamus for dyskinesia.Stereotact Funct Neurosurg,2001,76:79-86.
8.刘宗惠.脑立体定向技术临床应用新进展.中华神经外科疾病研究杂志,2003.2:1-3.
9.杨光华主编.病理学,第五版.北京:人民卫生出版社,2002,1-6.
10.李甘地主编.病理学,第六版.北京:人民卫生出版社,2001,1-10.
11.邱胜利.立体定向颅内病灶活检术.立体定向和功能性神经外科杂志,2005.18:189-191.
12.于新,刘宗惠,李士月,等.立体定向脑内病变活检方法临床研究.医学研究通讯,2005,34:29-30.
13.Alesch F,Pappaterra J,Trattnig S,et al.The role of stereotactic biopsy in radiosurgery.Acts Neurochir(Suppl),1995,63:20.
14.Revesz T,Scaravilli F,Coutinho L,et al.Reliability of histological diagnosis including grading in gliomas biopsied by image-guided stereotactic technique.Brain,1993,116:781.
15.Apuzzo MLJ,Sabshin JK.Computed tomograprahic guidance stereotatics in the management of intracranial mass lsions.Neurosurgery,1983,12:277.
16.Mundinger F,Ostertag CB,Birg W,et al.Stereotatic treat ment of brain lesions:Biopsy interstitial radiotherapy(Iridium-192 and Iod ine-125)and drainage procedures.Appl Neurophysiol,1980,43:198.
17.Kelly PJ,Daumas-Duport C,Kispert DB,et al.Imaging-based stereotactic serial biopsy in untreated intracranial glial neoplasms.J Neurosurg,1987,66:865-874.
18.Bemstein M,Laperriere N,Leung P,et al.Interstitial brachyrherapy for malignant brain tumors preliminary results.Neurosurgery,1990,26:371.
19.Kelly PL.Computer assisted stereotactic biopsy and volumetric resection of pediatric brain tumors.Neurlogic Clinics,1991,9:317.
20.Spiegel EA,Wycis HT,Marks M,et al.Stereotaxic apparatus for operation on the human brain.Science,1947,106:349.
21.Fischgold H,David M,Talairach J,et al.Direct opacifying injections into the venous system of the head.Acta Radiologica,1953,40:128-38.
22.李涛.立体定向活检技术在颅内占位性病变临床治疗中的指导意义.中国医药导刊,2006,8:431.
23.Kelly PJ.Compute-assisted stereotactic biopsy and volumetric resection of pediatric brain tumors.Neurologic clinics,1991,9:317-336.
24.Hall WA.The safety and efficacy of stereotactic brain biopsy for intracranial lesions.Cancer,1998,82:1769-1755.
25.Gerdes JS,Hitchin PW,Neerangun W,et al.Computed tomography versus magnetic resonance imaging in steretactic localization.Stereotact Func Neurosurg,1994,63:124-129.
26.Mundinger F.CT-stereotactic biopsy for optimizing the therapy of intracranial processes.Acta Neurochir(Suppl),1985,35:70-74.
27.Apuzzo MLJ,Chandrasoma PT,Cohen D,et al.Computed imaging stereotaxy:experience and perspective related to 500 procedures applied to brain masses.Neruosurgery,1987,20:930-937.
28.Wen DY,Hall WA,Miller DA,et al.Targeted brain biopsy:a comparison of freehand computed tomography-guided and stereotactic techniques.Neurosurgery,1993,32:407-413.
29.Lee T,Kenny BG,Hitchcock ER,et al.Supratentorial masses:Stereotactic or freehand biopsy.Br J Neurosurg,1991,5:331-338.
30.刘宗惠,于新,李士月,等.脑深部病变立体定向活检方法的研究.中华医学杂志,2002,82:225-228.
31.Greenblatt SH,Rayport M,Savolaine ER,et al.Computed tomographyguided intracranial biopsy and cyst aspiration.Neurosurgery,1982,11:589.
32.Wickham J,Fitzpatrick J.Minimally invasive surgery.Br J Surg,1990,77:721.
33.Chandrasoma PT,Smith MM,Apuzzo MLJ.Stereotactic biopsy in the diagnosis of brain masses:comparison of results of biopsy and resected surgical specimen.Neurosurgery,1989,24:160-165.
34.Javedan SP,Tamargo RJ.Diagnostic yield of brain biopsy in neurodegenera- tive disorders.Neurosurgery,1997,41:823-830.
35.Arbit E,Galicich JH.Importance of image-guided stereotactic biopsy to confirm diagnosis in an oncological setting.Ann Surg Oncel,1994,1:368-372.
36.Liu ZH,Yu X,Tian ZM,et al.CT-guided stereotactic biopsy of deep brain lesions.Med J Chin PLA,1996,21:279-281.
37.Anderson NE,Willoughby EW,Syneck BJ,et al.Brain biopsy in the management of focal encephalitis.J Neurol Neurosurg Psychiatry,1991,54:1001-1003.
38.Blaauw G,Braakman R.Pitfalls in diagnostic stereotactic brain surgery.Acta Neurochir(Wien),(Suppl)1988,42:161-165.
39.Whiting DM,Barnett GH,Estes ML,et al.Stereotactic biopsy of nonneoplastic lesions in adults.Cleve Clin J Med,1992,59:48-55.
40.Benabid A,Blond S,Chazal J,et al.Stereotaxic biopsies(SB)of intracranial neoplasms.Considerations apropos of 3,052 cases.Neuro-Chirurgie,1985,31:295-301.
41.Mundinger F,Ostertag ch B,Birg W,ed al.Stereotactic treatment of brain lesions:Biopsy Interstitial Radiotherapy(Iridium-192 and Iodine-125)and Drainage procedures.Appl Neurophysiol,1980,43:198.
42.Edner G.Stereotatic biopsy of intracranial space occupying lesigns.Acta Neurochir(wien),1981,57:213.
43.Kelly PJ.Computer asmsted stereotactic biopsy and volumetric resection of pediatric brain tumors.Neurologlc Ctinits,1991,9:317.
44.许建平,汪业汉,徐复华,等.脑立体定向仪临床应用100次性能小结.中国医疗器械杂志,1978:7-8.
45.潘力.蒋大介,江澄川.CT立体定向脑深部病变活检术初步报告.中国 神经精神疾病杂志,1988,14:209-211.
46.董意如,林友俊,李耀华,等.134次脑立体定向手术临床分析.南京铁路医院学报,1987,6:19-21.
47.朱炎昌,蒋先惠,薛德林,等.CT脑立体定向术的初步临床应用.中国神经精神疾病杂志,1989,15:23-25.
48.柳学国,王承缘,郭俊渊,等.CT脑立体定向装置及CT立体定向脑活检.冶会医药情报,1989,6:85-86.
49.郑立高,孟忠诚,郑焦岩,等.CT定位的立体定向术临床应用.功能性和主体定向神经外科杂志,1990,3:20-22.
50.彭雪明,孙昌兰,史庭慧,等.CT立体定向术脑组织活检32例分析.中国神经精神疾病杂志,1990,16:149-151.
51.丁学华,朱诚,张光霁,等.磁共振辅助X-CT立体定向在深部脑肿瘤活检中的应用.立体定向和功能性神经外科杂志,1993,6:7-8.
52.谭启富.孙康健,孙克华,等.应用ASA一601S高精度脑立体定向仪诊断和治疗颅内病变的初步经验.功能性和立体定向神经外科杂志.1994,7:4-5.
53.付先明,汪业汉,成良正.松果体区肿瘤立体定向活检.立体定向和功能性神经外科杂志,1995,8:14-15.
54.李杨彬,李树欣.CT引导脑立体定向活检的评价.影像诊断与介入放射学.1995,4:12-13.
55.刘宗惠,于新,田增民,等.CT引导立体定向脑深部病灶活检术(附241例临床分析).微侵袭神经外科杂志,1996,1:15-17.
56.Yu Xin,Lin Zonghui,Tian Zengmin,et al.CT-guided stereotactic biopsy of deep brain lesions:report of 310 cases.China Med,1998,111:361-363.
57.田增民,刘宗惠,康桂泉,等.CT引导1000例脑立体定向手术临床分析. 微侵袭神经外科杂志,1996,1:103-105.
58.田增民,刘宗惠,康桂泉,等.CT引导立体定向手术1115例临床分析.中国神经精神疾病杂志,1996,22:260-262.
59.王宗敏,林岩崇,郑荣远,等.脑组织立体定向穿刺活检76例分析.温州医学院学报,1996,26:217-219.
60.袁树斌,张捷,曾凡俊,等.提高颅内病变立体定向活检准确率的体会.立体定向和功能性神经外科杂志,1996,9:16-17.
61.于新,刘宗惠,阳增民,等.脑深部病变立体定向活检方法的临床研究.功能性和立体定向神经外科杂志,1997,10:9-12.
62.张晓鹏,朱诚,张光霁,等.颅内病变行CT导向立体定向手术60例临床报告.中华神经外科杂志,1997,13:59-60.
63.丁学华,朱诚,卢亦成,等.立体定向技术行脑深部病变131例活检和治疗的临床分析.功能性和立体定向神经外科杂志,1997,10:6-7.
64.陈伟建,诸葛启钏,王宗敏,等.CT立体定向脑组织活检90例分析.现代医用影像学,1998,7:58-60.
65.陈继锁,张月松,赵军,等.PET辅助下脑立体定向活检术.功能性和立体定向神经外科杂志,1998,11:4-5.
66.徐元昌,顾明,袁树斌,等.CT定位脑立体定向术在颅内病变活检中的应用.中国医学影像技术,1999,15:196.
67.曲渊,吴波.39例CT引导立体定向脑活检术快速病理诊断和常规病理诊断比较分析.诊断病理学杂志,2000,7:124-126.
68.廖述才,袁树斌,孙守岐,等.立体定向活检在_刀治疗病变中应用25例报告.立体定向和功能性神经外科杂志,2000,13:139.
69.林志国,李庆国,沈红,等.立体定向活检在X_刀治疗中应用体会.立体定向和功能性神经外科杂志,2000,13:41.
70.于新,刘宗惠,田增民,等.CT、MRI引导立体定向脑活检术的临床研究.中国神经精神疾病杂志,2001,27:352-354.
71.魏祥品,汪业汉,傅先明,等.影响立体定向活检的相关因素分析.立体定向和功能性神经外科杂志,2001,14:202-205.
72.李爱民,吴海滨,陈覃,等.立体定向导向活检和显微外科手术治疗颅内病变.立体定向和功能性神经外科杂志,2002,15:36-37.
73.张志远,李彦和,徐德生,等.脑立体定向活检术的临床应用与分析附393例报告.天津医科大学学报,2002,8:339-241.
74.刘志雄,侯永宏,方加胜,等.脑内病灶的计算机辅助立体定向活检.中国现代医学杂志,2003,13:106-109.
75.张宇清,赵国光,李坤成,等.MRI导向立体定向活检手术在颅内疑难病例诊断中的应用.中华外科杂志,2003,41:667-669.
76.刘宗惠,陈琳,于新,等.805例立体定向脑活检报告.中国神经精神疾病杂志,2004,30:401-404.
77.于新,亓树彬,翟忠太,等.微侵袭性立体定向活检技术的临床应用研究.中国实验诊断学,2004,8:619-622.
78.王进刚,黄文辉,胡滨,等.立体定向脑活检术58例经验总结.中国微侵袭神经外科杂志,2004,9:462-463.
79.王学廉,贺世明,梁秦川,等.影像学引导的立体定向活检在脑疾病诊断中的价值附50例临床分析.立体定向和功能性神经外科杂志,2006.19:70-74.
80.黄文辉,李俊德,王进钢,等.MRI定位下立体定向活检术在颅内多发疑难病例诊断中的应用.立体定向和功能性神经外科杂志,2006,19:65-69.
81.魏祥品,傅先明,汪业汉,等.颅内特殊部位病变的立体定向活检术.中国临床神经外科杂志,2006,11:591-593.
82.穆春蕾,张强,王旭光,等.CT定位下立体定向活检在颅内疑难病例诊断中的应用.徐州医学院学报,2006,14:584-586.
83.何江弘,赵春平,魏群,等.CT、MRI引导下立体定向颅内病变活检.立体定向和功能性神经外科杂志,2006,19:75-78.
84.Lafitte E,Morel-Precetti S,Martin-uvernuil,et al.Multiple glioblastomas:CT and MR features.Eur Radiol,2001,11:131.
85.Djalilian HR,Shah MV,Hall WA.Radiographic incidence of multicentric malignant gliomas.Surg Neurol,1999,51:554.
86.Barnard RO,Geddes JF.The incidence of multifocal cerebral gliomas.A histologic study of large hemisphere sections.Cancer,1987,60:1519-31.
87.罗林,李能德,郑勤,等.颅内多发性胶质瘤23例分析.昆明医学院学报,1998,19:78-79.
88.Salvati M,Caroli E,Orlando ER,et al.Multicentric gliomas:our experience in 25 patients and critical review of the literature.Neurosurg Rev 2003,26:275.
89.Kyritsis AP,Levin VA,Yung WK,et al.Imaging patterns of multifocal gliomas.European Journal of Radiology,1993,16:163-70.
90.Bao S,Wu Q,Sathornsumetee S,et al.Stem cell-like glioma cells promote tumor angiogenesis throatily vascular endothelial growth factor.Cancer Res,2006,66:7843-7848.
91.Clarke MF,Dick JE,Dirks PB,et al.Cancer stem cells-perspectives on current status an d future directions:AACR workshop On cancer stem cells.Cancer Res,2006,66:9339-9344.
92.朱玉德,季晓燕,黄强,等.人脑胶质瘤干细胞初步研究.中华神经外科杂志,2007,23:127-130.
93.Zamponi N,Rychlicki F,Ducati A,et al.Multicentric glioma with unusual clinical presentation.Childs Nervous System,2001,17:101-105.
94.方雷,余永强,钱银锋,等.颅内多发性胶质瘤的CT与MRI特征.临床放射学杂志,2006,25:313-315.
95.Synowitz M,von Eckardstein K,Brauer C,et al.Case history:multicentric glioma with involvement of the optic chiasm.Clinical Neurology &Neurosurgery,2002,105:66-8.
96.Jomin M,Lesoin F,Lozes G,et al.Multifocal glioma.Apropos of 10 cases.Neurochirurgie,1983,29:41-6.
97.Salvati M,Cervoni L,Celli P,et al.Multicentric and multifocal primary cerebral tumors.Methods of diagnosis and treatment.Ital J Neurol Sci,1997,18:17-20.
98.钱银锋,余永强,郑斐群,等.磁共振灌注成像对高级胶质瘤、转移瘤及脑脓肿的鉴别诊断价值.中国医学影像技术,2003,19:149.
99.董长征,赵文清,李文玲,等.立体定向活检术确诊多发性颅内胶质瘤8例.河北医药,2007,29:30-31.
100.Borovich B,Mays M,Gellei B,et al.Multifocal glioma of the brain.J Neurosurg,1976,45:229-232.
101.Shiefer W,Hasenbein B,Schmidt H.Multicentric glioblastoma:methods of diagnosis and treatment.Acta Neurochir,1978,42:89-95.
102.Oi S.Computerized axial tomography in the diagnosis of multiple brain tumors-correlations with angiography and nuclear scanning.No Shinkei Geka- Neurological Surgery,1977,5:833-840.
103.Loseke N,Dajez P,Retif J.Multicentric gliomas.Report of a case Acta Neurologica Belgica,1979,79:338-346.
104.Budka H, Podreka I, Reisner T, et al. Diagnostic and pathomorphological aspects of glioma multiplicity. Neurosurgical Review,1980, 3:233-241.
105.Kitahara M, Wada T, Sato T. 2 cases of multicentric glioma. No Shinkei Geka - Neurological Surgery, 1982, 10:1313-1317.
106.Godlewski A, Szczech J. A case of primary multifocal glioblastoma multi-forme of the brain. Neurologia Neurochirurgia Polska,1986, 20: 271- 274.
107.Nakase H, Hisanaga M, Iwanaga H. An autopsy case of multicentric glioma of multiple histopathology. No Shinkei Geka-Neurological Surgery, 1987, 15:1073-1077.
108.Kato T, Aida T, Abe H, Ogata, et al. Clinico pathological study of multiple gliomas-report of three cases. Neurologia Medico-Chirurgica, 1990, 30: 604-609.
109.Mishra HB, Haran JP, Singh JP, et al. Multicentric gliomas: two case reports and a review of the literature. BrJ Neurosurgery, 1990,4: 535-539.
110.Pell MF, Revesz T, Thomas DG. Multicentric malignant glioma. British Journal of Neurosurgery, 1991, 5:631-634
111.Kyritsis A, Levin VA, Yung WKA, et al. Imaging patterns of multifocal gliomas. Eur J Radiol,1993, 16:163-170.
112.Franzini A, Leocata F, Giorgi C, et al. Role of stereo tactic biopsy in multifocal brain lesions: considerations on 100 consecutive cases. J Neurol Neurosurg Psychiatry, 1994, 57:957-960.
113.Zamponi N, Rychlicki F, Ducati A, et al. Multicentric glioma with unusual clinical presentation. Childs Nervous System,2001, 17:101-105
114.Baker MJ, Brem S, Daniels S, et al. Complete response of a recurrent, multicentric malignant glioma in a patient treated with phenylbutyrate Journal of Neuro-Oncology,2002,59:239-242.
115.Kaku S,Terao T,Taya K,A et al.Multicentric glioma presenting different pathological appearances:a case report No Shinkei Geka - Neurological Surgery,2004,32:501-506.
116.Zaki HS,Jenkinson MD,Du Plessis DG,et al.Vanishing contrast enhancement in malignant glioma after corticosteroid treatment.Acta Neurochir (Wien),2004,146:841-845.
117.Burzynski SR,Weaver RA.Lewy RI,et al.Phase Ⅱ study of antineoplaston A10 and AS2-1 in children with recurrent and progressive multicentric glioma:a preliminary report.Drugs in R & D,2004,5:315-526.
118.Aure K,Laigle-Donadey F,Kaloshi G,et al.Multiple gliomas:clinical studies and pathophysiological hypothesis.Revue Neurologique,2006,162:845-851.
119.孙鹏,杨新生,孟庆海,等.颅内多发性胶质瘤(附9例报告).齐鲁医学杂志,1999,14:45-46.
120.Jelsma R,Bucy PC.The treatment of glioblastoma multiforme of the brain.J Neurosci,1967,27:338-400.
121.Marshall LF,Jennet B,Longot KW.Needle biopsy for the diagnosis of malignant gliomas.JAMA,1974,228:1417-1418.
122.Chadduck WM,Roycroft D,Brown MW.Multicentric glioma as a cause of multiple cerebral lesions.Neurosurgery,1983,13:170-175.
123.孙鹏,孟庆海,韩昆,等.颅内多灶性与多中心性胶质瘤的综合治疗.齐鲁医学杂志,2000,15:93-94.
124.Baker Matthew,Brem Steven,Daniels S,et al.Complete response of a recurrent,multicentric malignant glioma in a patient treated with phenyl butyrate Journal of Neuro-Oncology,2002,59:239-242.
125.Hirko Ohgaki.Population-Based Studies on Incidence,Survival Rates,and Genetic Alterations in Astrocytic and Oligodendroglial Gliomas.J Neuropathol Exp Neurol,2005,64:479-489.
126.江涛,王忠诚.构建胶质瘤综合治疗体系.河北医药,2007,29:3-6.
127.Hirko Ohgaki.Population-Based Studies on Incidence,Survival Rates,and Genetic Alterations in Astrocytic and Oligodendroglial Gliomas.J Neuropathol Exp Neurol,2005,64:479-489.
2.Djalilian HR,Shah MV,Hall WA.Radiographic incidence of multicentric malignant gliomas.Surg Neurol,1999,51:554.
3.田增民主编.现代立体定向神经外科学.第1版.北京:中国科学技术出版社,1997,114.
4.李甘地主编.病理学,第六版.北京:人民卫生出版社,2001,1-10.
5.邱胜利.立体定向颅内病灶活检术.立体定向和功能性神经外科杂志,2005.18:189-191.
6.Hall WA.The safety and efficacy of stereotactic brain biopsy for intracranial lesions.Cancer,1998,82:1769-1755.
7.Gerdes JS,Hitchin PW,Neerangun W,et al.Computed tomography versus magnetic resonance imaging in steretactic localization.Stereotact Func Neurosurg,1994,63:124-129.
8.Mundinger F.CT-stereotactic biopsy for optimizing the therapy of intracranial processes.Acta Neurochir(Suppl),1985,35:70-74.
9.Apuzzo MLJ,Chandrasoma PT,Cohen D,et al.Computed imaging stereotaxy:experience and perspective related to 500 procedures applied to brain masses.Neruosurgery,1987,20:930-937.
10.Salvati M,Caroli E,Orlando ER,et al.Multicentric gliomas:our experience in 25 patients and critical review of the literature.Neurosurg Rev 2003,26:275.
11.Lafitte E,Morel-Precetti S,Martin-uvernuil,et al,Multiple glioblastomas:CT and MR features.Eur Radiol,2001,11:131.
12.Zamponi N,Rychlicki F,Ducati A,et al.Multicentric glioma with unusual clinical presentation.Childs Nervous System,2001,17:101-105.
13.方雷,余永强,钱银锋,等.颅内多发性胶质瘤的CT与MRI特征.临床放射学杂志,2006,25:313-315.
14.田宇,艾天贻,赵兴利,等.立体定向手术中确定三维长轴和人颅点的方法-“四点一线手算法”.立体定向和功能性神经外科杂志,2007,20:48-49.
15.Rajshekhar V.Current assisted stereotactic biopsy and volumetric resection of pediatric brain tumors,Neurologic Clinics,1991;9:317-336.
16.Bhardwaj RD,Bemstein M.Prospectiva feasibility study of outpatient stereotactic brain lesion biopsy.Neumsurgery,2002,51:358-361.
17.Matthew J McGirt,Alan T Villavicencio.MRI-Guided Stereotactic Biopsy in the Djagnosis of Glloma:Comparison of Biopsy and Surgical Resection Specimen.SurgNeurol,2003,59:277-281.
18.于新,刘宗惠.微侵袭立体定向活检方法的研究.中华神经外杂志,2001,17:354-356.
19.王进刚,黄文辉,胡滨,等.立体定向脑活检术58例经验总结.中国微侵袭神经外科杂志,2004,9:462-463.
20.Landy HJ,Lee TT,Potter P,et al.Early MRI findings in high grade glioma.J Neurooncol,2000,47:65-72.
21.Gerdes JS,Hitchin PW,Neerangun W,et al.Computed tomography versus magnetic resonance imaging in steretactic localization.Stereotact Func Neurosurg,1994,63:124-129.
22.Kim Jh,Gildenberg PI.Stereotactic biopsy.In:Gilderduerg PL,Tasker RR (eds).Textbook of Stereotactic and Functional Neuresurgery.New York:Mc Graw-Hill,1998:387-396.
23.Chandrasoma PT,Smith MM,Apuzzo MLJ.Stereotactic biopsy in the diagnosis of brain masses:comparison of results of biopsy and resected surgical specimen.Neurosurgery,1989,24:160-165.
24.刘宗惠,陈琳.805例立体定向脑活检报告.中国神经精神疾病杂 志,2004,30:401-404.
25.Alesch F,Pappaterra J,Trattnig S,et al.The role of stereotactic biopsy in radiosurgery.Acts Neurochir(Suppl),1995,63:20.
26.Gonealves-Ferreira AJ,Herculano-Carvaho M.et al.Stereotactic biopsies of focal brainsten lesions.Surg Neurol,2003,60:311-320.
27.汪业汉,吴承远主编.立体定向神经外科手术学.北京:人民卫生出版社,2005:195-196.
28.李书成,刘永吉.多发性胶质瘤和多中心肿瘤.中华神经外科杂志,1988,23.
29.潘力,蒋大介,江澄川.CT立体定向脑深部病变活检术 初步报告.中国神经精神疾病杂志,1988,14:209-211.
30.刘宗惠,于新,田增民,等.CT引导立体定向脑深部病灶活检术(附241例临床分析).微侵袭神经外科杂志,1996,1:15-17.
31.董长征,赵文清,李文玲,等.立体定向活检术确诊多发性颅内胶质瘤8例.河北医药,2007,29:30-31.
32.Mishra HB,Haran JP,Singh JP,et al.Multicentric gliomas:two case reports and a review of the literature.BrJ Neurosurgery,1990,4:535-539.
33.Pell MF,Revesz T,Thomas DG.Multicentric malignant glioma.British Journal of Neurosurgery,1991,5:631-634
34.Franzini A,Leocata F,Giorgi C,et al.Role of stereo tactic biopsy in multifocal brain lesions:considerations on 100 consecutive cases.J Neurol Neurosurg Psychiatry,1994,57:957-960.
35.Zaki HS,Jenkinson MD,Du Plessis DG,et al.Vanishing contrast enhancement in malignant glioma after corticosteroid treatment.Acta Neurochir(Wien),2004,146:841-845.
36.Zamponi N,Rychlicki F,Ducati A,et al.Multicentric glioma with unusual clinical presentation.Childs Nervous System,2001,17:101-105.
37.Lafitte E,Morel-Precetti S,Martin-uvernuil,et al.Multiple glioblastomas:CT and MR features.Eur Radiol,2001,11:131.
38.Synowitz M,von Eckardstein K,Brauer C,et al.Case history:multicentric glioma with involvement of the optic chiasm.Clinical Neurology &Neurosurgery,2002,105:66-8.
39.Jomin M,Lesoin F,Lozes G,et al.Multifocal glioma.Apropos of 10 cases.Neurochirurgie,1983,29:41-6.
40.Salvati M,Cervoni L,Celli P,et al.Multicentric and multifocal primary cerebral tumors.Methods of diagnosis and treatment.Ital J Neurol Sci,1997,18:17-20.
41.Barnard RO,Geddes JF.The incidence of multifocal cerebral gliomas.A histologic study of large hemisphere sections.Cancer.1987,60:1519-31.
42.孙鹏,杨新生,孟庆海,等.颅内多发性胶质瘤(附9例报告).齐鲁医学杂志,1999,14:45-46.
43.Jelsma R,Bucy PC.The treatment of glioblastoma multiforme of the brain.J Neurosci,1967,27:338-400.
44.Marshall LF,Jennet B,Longot KW.Needle biopsy for the diagnosis of malignant gliomas.JAMA,1974,228:1417-1418.
45.Chadduck WM,Roycroft D,Brown MW.Multicentric glioma as a cause of multiple cerebral lesions.Neurosurgery,1983,13:170-175.
1.刘宗惠主编.实用立体定向及功能性神经外科学.北京:人民军医出版社,2006.1-164.
2.傅先明,牛朝诗主编.立体定向和功能性神经外科学.合肥:安徽科学技术出版社出版,2004,1-286.
3.田增民.立体定向功能神经外科的发展趋势.中华神经医学杂志,2003,2,2-5.
4.田增民.立体定向神经外科发展动向与趋势.中华神经外科疾病研究杂志,2003.2:289-292.
5.田增民主编.现代立体定向神经外科学.北京:中国科学技术出版社,1997,9-31.
6.Rajshekhar V.Gurrenl status of stereotatic biopsy.Stereotact Funct Neurosurg,2001,76:33-39.
7.Ohye C,Shibazaki T.Lesioning the thealamus for dyskinesia.Stereotact Funct Neurosurg,2001,76:79-86.
8.刘宗惠.脑立体定向技术临床应用新进展.中华神经外科疾病研究杂志,2003.2:1-3.
9.杨光华主编.病理学,第五版.北京:人民卫生出版社,2002,1-6.
10.李甘地主编.病理学,第六版.北京:人民卫生出版社,2001,1-10.
11.邱胜利.立体定向颅内病灶活检术.立体定向和功能性神经外科杂志,2005.18:189-191.
12.于新,刘宗惠,李士月,等.立体定向脑内病变活检方法临床研究.医学研究通讯,2005,34:29-30.
13.Alesch F,Pappaterra J,Trattnig S,et al.The role of stereotactic biopsy in radiosurgery.Acts Neurochir(Suppl),1995,63:20.
14.Revesz T,Scaravilli F,Coutinho L,et al.Reliability of histological diagnosis including grading in gliomas biopsied by image-guided stereotactic technique.Brain,1993,116:781.
15.Apuzzo MLJ,Sabshin JK.Computed tomograprahic guidance stereotatics in the management of intracranial mass lsions.Neurosurgery,1983,12:277.
16.Mundinger F,Ostertag CB,Birg W,et al.Stereotatic treat ment of brain lesions:Biopsy interstitial radiotherapy(Iridium-192 and Iod ine-125)and drainage procedures.Appl Neurophysiol,1980,43:198.
17.Kelly PJ,Daumas-Duport C,Kispert DB,et al.Imaging-based stereotactic serial biopsy in untreated intracranial glial neoplasms.J Neurosurg,1987,66:865-874.
18.Bemstein M,Laperriere N,Leung P,et al.Interstitial brachyrherapy for malignant brain tumors preliminary results.Neurosurgery,1990,26:371.
19.Kelly PL.Computer assisted stereotactic biopsy and volumetric resection of pediatric brain tumors.Neurlogic Clinics,1991,9:317.
20.Spiegel EA,Wycis HT,Marks M,et al.Stereotaxic apparatus for operation on the human brain.Science,1947,106:349.
21.Fischgold H,David M,Talairach J,et al.Direct opacifying injections into the venous system of the head.Acta Radiologica,1953,40:128-38.
22.李涛.立体定向活检技术在颅内占位性病变临床治疗中的指导意义.中国医药导刊,2006,8:431.
23.Kelly PJ.Compute-assisted stereotactic biopsy and volumetric resection of pediatric brain tumors.Neurologic clinics,1991,9:317-336.
24.Hall WA.The safety and efficacy of stereotactic brain biopsy for intracranial lesions.Cancer,1998,82:1769-1755.
25.Gerdes JS,Hitchin PW,Neerangun W,et al.Computed tomography versus magnetic resonance imaging in steretactic localization.Stereotact Func Neurosurg,1994,63:124-129.
26.Mundinger F.CT-stereotactic biopsy for optimizing the therapy of intracranial processes.Acta Neurochir(Suppl),1985,35:70-74.
27.Apuzzo MLJ,Chandrasoma PT,Cohen D,et al.Computed imaging stereotaxy:experience and perspective related to 500 procedures applied to brain masses.Neruosurgery,1987,20:930-937.
28.Wen DY,Hall WA,Miller DA,et al.Targeted brain biopsy:a comparison of freehand computed tomography-guided and stereotactic techniques.Neurosurgery,1993,32:407-413.
29.Lee T,Kenny BG,Hitchcock ER,et al.Supratentorial masses:Stereotactic or freehand biopsy.Br J Neurosurg,1991,5:331-338.
30.刘宗惠,于新,李士月,等.脑深部病变立体定向活检方法的研究.中华医学杂志,2002,82:225-228.
31.Greenblatt SH,Rayport M,Savolaine ER,et al.Computed tomographyguided intracranial biopsy and cyst aspiration.Neurosurgery,1982,11:589.
32.Wickham J,Fitzpatrick J.Minimally invasive surgery.Br J Surg,1990,77:721.
33.Chandrasoma PT,Smith MM,Apuzzo MLJ.Stereotactic biopsy in the diagnosis of brain masses:comparison of results of biopsy and resected surgical specimen.Neurosurgery,1989,24:160-165.
34.Javedan SP,Tamargo RJ.Diagnostic yield of brain biopsy in neurodegenera- tive disorders.Neurosurgery,1997,41:823-830.
35.Arbit E,Galicich JH.Importance of image-guided stereotactic biopsy to confirm diagnosis in an oncological setting.Ann Surg Oncel,1994,1:368-372.
36.Liu ZH,Yu X,Tian ZM,et al.CT-guided stereotactic biopsy of deep brain lesions.Med J Chin PLA,1996,21:279-281.
37.Anderson NE,Willoughby EW,Syneck BJ,et al.Brain biopsy in the management of focal encephalitis.J Neurol Neurosurg Psychiatry,1991,54:1001-1003.
38.Blaauw G,Braakman R.Pitfalls in diagnostic stereotactic brain surgery.Acta Neurochir(Wien),(Suppl)1988,42:161-165.
39.Whiting DM,Barnett GH,Estes ML,et al.Stereotactic biopsy of nonneoplastic lesions in adults.Cleve Clin J Med,1992,59:48-55.
40.Benabid A,Blond S,Chazal J,et al.Stereotaxic biopsies(SB)of intracranial neoplasms.Considerations apropos of 3,052 cases.Neuro-Chirurgie,1985,31:295-301.
41.Mundinger F,Ostertag ch B,Birg W,ed al.Stereotactic treatment of brain lesions:Biopsy Interstitial Radiotherapy(Iridium-192 and Iodine-125)and Drainage procedures.Appl Neurophysiol,1980,43:198.
42.Edner G.Stereotatic biopsy of intracranial space occupying lesigns.Acta Neurochir(wien),1981,57:213.
43.Kelly PJ.Computer asmsted stereotactic biopsy and volumetric resection of pediatric brain tumors.Neurologlc Ctinits,1991,9:317.
44.许建平,汪业汉,徐复华,等.脑立体定向仪临床应用100次性能小结.中国医疗器械杂志,1978:7-8.
45.潘力.蒋大介,江澄川.CT立体定向脑深部病变活检术初步报告.中国 神经精神疾病杂志,1988,14:209-211.
46.董意如,林友俊,李耀华,等.134次脑立体定向手术临床分析.南京铁路医院学报,1987,6:19-21.
47.朱炎昌,蒋先惠,薛德林,等.CT脑立体定向术的初步临床应用.中国神经精神疾病杂志,1989,15:23-25.
48.柳学国,王承缘,郭俊渊,等.CT脑立体定向装置及CT立体定向脑活检.冶会医药情报,1989,6:85-86.
49.郑立高,孟忠诚,郑焦岩,等.CT定位的立体定向术临床应用.功能性和主体定向神经外科杂志,1990,3:20-22.
50.彭雪明,孙昌兰,史庭慧,等.CT立体定向术脑组织活检32例分析.中国神经精神疾病杂志,1990,16:149-151.
51.丁学华,朱诚,张光霁,等.磁共振辅助X-CT立体定向在深部脑肿瘤活检中的应用.立体定向和功能性神经外科杂志,1993,6:7-8.
52.谭启富.孙康健,孙克华,等.应用ASA一601S高精度脑立体定向仪诊断和治疗颅内病变的初步经验.功能性和立体定向神经外科杂志.1994,7:4-5.
53.付先明,汪业汉,成良正.松果体区肿瘤立体定向活检.立体定向和功能性神经外科杂志,1995,8:14-15.
54.李杨彬,李树欣.CT引导脑立体定向活检的评价.影像诊断与介入放射学.1995,4:12-13.
55.刘宗惠,于新,田增民,等.CT引导立体定向脑深部病灶活检术(附241例临床分析).微侵袭神经外科杂志,1996,1:15-17.
56.Yu Xin,Lin Zonghui,Tian Zengmin,et al.CT-guided stereotactic biopsy of deep brain lesions:report of 310 cases.China Med,1998,111:361-363.
57.田增民,刘宗惠,康桂泉,等.CT引导1000例脑立体定向手术临床分析. 微侵袭神经外科杂志,1996,1:103-105.
58.田增民,刘宗惠,康桂泉,等.CT引导立体定向手术1115例临床分析.中国神经精神疾病杂志,1996,22:260-262.
59.王宗敏,林岩崇,郑荣远,等.脑组织立体定向穿刺活检76例分析.温州医学院学报,1996,26:217-219.
60.袁树斌,张捷,曾凡俊,等.提高颅内病变立体定向活检准确率的体会.立体定向和功能性神经外科杂志,1996,9:16-17.
61.于新,刘宗惠,阳增民,等.脑深部病变立体定向活检方法的临床研究.功能性和立体定向神经外科杂志,1997,10:9-12.
62.张晓鹏,朱诚,张光霁,等.颅内病变行CT导向立体定向手术60例临床报告.中华神经外科杂志,1997,13:59-60.
63.丁学华,朱诚,卢亦成,等.立体定向技术行脑深部病变131例活检和治疗的临床分析.功能性和立体定向神经外科杂志,1997,10:6-7.
64.陈伟建,诸葛启钏,王宗敏,等.CT立体定向脑组织活检90例分析.现代医用影像学,1998,7:58-60.
65.陈继锁,张月松,赵军,等.PET辅助下脑立体定向活检术.功能性和立体定向神经外科杂志,1998,11:4-5.
66.徐元昌,顾明,袁树斌,等.CT定位脑立体定向术在颅内病变活检中的应用.中国医学影像技术,1999,15:196.
67.曲渊,吴波.39例CT引导立体定向脑活检术快速病理诊断和常规病理诊断比较分析.诊断病理学杂志,2000,7:124-126.
68.廖述才,袁树斌,孙守岐,等.立体定向活检在_刀治疗病变中应用25例报告.立体定向和功能性神经外科杂志,2000,13:139.
69.林志国,李庆国,沈红,等.立体定向活检在X_刀治疗中应用体会.立体定向和功能性神经外科杂志,2000,13:41.
70.于新,刘宗惠,田增民,等.CT、MRI引导立体定向脑活检术的临床研究.中国神经精神疾病杂志,2001,27:352-354.
71.魏祥品,汪业汉,傅先明,等.影响立体定向活检的相关因素分析.立体定向和功能性神经外科杂志,2001,14:202-205.
72.李爱民,吴海滨,陈覃,等.立体定向导向活检和显微外科手术治疗颅内病变.立体定向和功能性神经外科杂志,2002,15:36-37.
73.张志远,李彦和,徐德生,等.脑立体定向活检术的临床应用与分析附393例报告.天津医科大学学报,2002,8:339-241.
74.刘志雄,侯永宏,方加胜,等.脑内病灶的计算机辅助立体定向活检.中国现代医学杂志,2003,13:106-109.
75.张宇清,赵国光,李坤成,等.MRI导向立体定向活检手术在颅内疑难病例诊断中的应用.中华外科杂志,2003,41:667-669.
76.刘宗惠,陈琳,于新,等.805例立体定向脑活检报告.中国神经精神疾病杂志,2004,30:401-404.
77.于新,亓树彬,翟忠太,等.微侵袭性立体定向活检技术的临床应用研究.中国实验诊断学,2004,8:619-622.
78.王进刚,黄文辉,胡滨,等.立体定向脑活检术58例经验总结.中国微侵袭神经外科杂志,2004,9:462-463.
79.王学廉,贺世明,梁秦川,等.影像学引导的立体定向活检在脑疾病诊断中的价值附50例临床分析.立体定向和功能性神经外科杂志,2006.19:70-74.
80.黄文辉,李俊德,王进钢,等.MRI定位下立体定向活检术在颅内多发疑难病例诊断中的应用.立体定向和功能性神经外科杂志,2006,19:65-69.
81.魏祥品,傅先明,汪业汉,等.颅内特殊部位病变的立体定向活检术.中国临床神经外科杂志,2006,11:591-593.
82.穆春蕾,张强,王旭光,等.CT定位下立体定向活检在颅内疑难病例诊断中的应用.徐州医学院学报,2006,14:584-586.
83.何江弘,赵春平,魏群,等.CT、MRI引导下立体定向颅内病变活检.立体定向和功能性神经外科杂志,2006,19:75-78.
84.Lafitte E,Morel-Precetti S,Martin-uvernuil,et al.Multiple glioblastomas:CT and MR features.Eur Radiol,2001,11:131.
85.Djalilian HR,Shah MV,Hall WA.Radiographic incidence of multicentric malignant gliomas.Surg Neurol,1999,51:554.
86.Barnard RO,Geddes JF.The incidence of multifocal cerebral gliomas.A histologic study of large hemisphere sections.Cancer,1987,60:1519-31.
87.罗林,李能德,郑勤,等.颅内多发性胶质瘤23例分析.昆明医学院学报,1998,19:78-79.
88.Salvati M,Caroli E,Orlando ER,et al.Multicentric gliomas:our experience in 25 patients and critical review of the literature.Neurosurg Rev 2003,26:275.
89.Kyritsis AP,Levin VA,Yung WK,et al.Imaging patterns of multifocal gliomas.European Journal of Radiology,1993,16:163-70.
90.Bao S,Wu Q,Sathornsumetee S,et al.Stem cell-like glioma cells promote tumor angiogenesis throatily vascular endothelial growth factor.Cancer Res,2006,66:7843-7848.
91.Clarke MF,Dick JE,Dirks PB,et al.Cancer stem cells-perspectives on current status an d future directions:AACR workshop On cancer stem cells.Cancer Res,2006,66:9339-9344.
92.朱玉德,季晓燕,黄强,等.人脑胶质瘤干细胞初步研究.中华神经外科杂志,2007,23:127-130.
93.Zamponi N,Rychlicki F,Ducati A,et al.Multicentric glioma with unusual clinical presentation.Childs Nervous System,2001,17:101-105.
94.方雷,余永强,钱银锋,等.颅内多发性胶质瘤的CT与MRI特征.临床放射学杂志,2006,25:313-315.
95.Synowitz M,von Eckardstein K,Brauer C,et al.Case history:multicentric glioma with involvement of the optic chiasm.Clinical Neurology &Neurosurgery,2002,105:66-8.
96.Jomin M,Lesoin F,Lozes G,et al.Multifocal glioma.Apropos of 10 cases.Neurochirurgie,1983,29:41-6.
97.Salvati M,Cervoni L,Celli P,et al.Multicentric and multifocal primary cerebral tumors.Methods of diagnosis and treatment.Ital J Neurol Sci,1997,18:17-20.
98.钱银锋,余永强,郑斐群,等.磁共振灌注成像对高级胶质瘤、转移瘤及脑脓肿的鉴别诊断价值.中国医学影像技术,2003,19:149.
99.董长征,赵文清,李文玲,等.立体定向活检术确诊多发性颅内胶质瘤8例.河北医药,2007,29:30-31.
100.Borovich B,Mays M,Gellei B,et al.Multifocal glioma of the brain.J Neurosurg,1976,45:229-232.
101.Shiefer W,Hasenbein B,Schmidt H.Multicentric glioblastoma:methods of diagnosis and treatment.Acta Neurochir,1978,42:89-95.
102.Oi S.Computerized axial tomography in the diagnosis of multiple brain tumors-correlations with angiography and nuclear scanning.No Shinkei Geka- Neurological Surgery,1977,5:833-840.
103.Loseke N,Dajez P,Retif J.Multicentric gliomas.Report of a case Acta Neurologica Belgica,1979,79:338-346.
104.Budka H, Podreka I, Reisner T, et al. Diagnostic and pathomorphological aspects of glioma multiplicity. Neurosurgical Review,1980, 3:233-241.
105.Kitahara M, Wada T, Sato T. 2 cases of multicentric glioma. No Shinkei Geka - Neurological Surgery, 1982, 10:1313-1317.
106.Godlewski A, Szczech J. A case of primary multifocal glioblastoma multi-forme of the brain. Neurologia Neurochirurgia Polska,1986, 20: 271- 274.
107.Nakase H, Hisanaga M, Iwanaga H. An autopsy case of multicentric glioma of multiple histopathology. No Shinkei Geka-Neurological Surgery, 1987, 15:1073-1077.
108.Kato T, Aida T, Abe H, Ogata, et al. Clinico pathological study of multiple gliomas-report of three cases. Neurologia Medico-Chirurgica, 1990, 30: 604-609.
109.Mishra HB, Haran JP, Singh JP, et al. Multicentric gliomas: two case reports and a review of the literature. BrJ Neurosurgery, 1990,4: 535-539.
110.Pell MF, Revesz T, Thomas DG. Multicentric malignant glioma. British Journal of Neurosurgery, 1991, 5:631-634
111.Kyritsis A, Levin VA, Yung WKA, et al. Imaging patterns of multifocal gliomas. Eur J Radiol,1993, 16:163-170.
112.Franzini A, Leocata F, Giorgi C, et al. Role of stereo tactic biopsy in multifocal brain lesions: considerations on 100 consecutive cases. J Neurol Neurosurg Psychiatry, 1994, 57:957-960.
113.Zamponi N, Rychlicki F, Ducati A, et al. Multicentric glioma with unusual clinical presentation. Childs Nervous System,2001, 17:101-105
114.Baker MJ, Brem S, Daniels S, et al. Complete response of a recurrent, multicentric malignant glioma in a patient treated with phenylbutyrate Journal of Neuro-Oncology,2002,59:239-242.
115.Kaku S,Terao T,Taya K,A et al.Multicentric glioma presenting different pathological appearances:a case report No Shinkei Geka - Neurological Surgery,2004,32:501-506.
116.Zaki HS,Jenkinson MD,Du Plessis DG,et al.Vanishing contrast enhancement in malignant glioma after corticosteroid treatment.Acta Neurochir (Wien),2004,146:841-845.
117.Burzynski SR,Weaver RA.Lewy RI,et al.Phase Ⅱ study of antineoplaston A10 and AS2-1 in children with recurrent and progressive multicentric glioma:a preliminary report.Drugs in R & D,2004,5:315-526.
118.Aure K,Laigle-Donadey F,Kaloshi G,et al.Multiple gliomas:clinical studies and pathophysiological hypothesis.Revue Neurologique,2006,162:845-851.
119.孙鹏,杨新生,孟庆海,等.颅内多发性胶质瘤(附9例报告).齐鲁医学杂志,1999,14:45-46.
120.Jelsma R,Bucy PC.The treatment of glioblastoma multiforme of the brain.J Neurosci,1967,27:338-400.
121.Marshall LF,Jennet B,Longot KW.Needle biopsy for the diagnosis of malignant gliomas.JAMA,1974,228:1417-1418.
122.Chadduck WM,Roycroft D,Brown MW.Multicentric glioma as a cause of multiple cerebral lesions.Neurosurgery,1983,13:170-175.
123.孙鹏,孟庆海,韩昆,等.颅内多灶性与多中心性胶质瘤的综合治疗.齐鲁医学杂志,2000,15:93-94.
124.Baker Matthew,Brem Steven,Daniels S,et al.Complete response of a recurrent,multicentric malignant glioma in a patient treated with phenyl butyrate Journal of Neuro-Oncology,2002,59:239-242.
125.Hirko Ohgaki.Population-Based Studies on Incidence,Survival Rates,and Genetic Alterations in Astrocytic and Oligodendroglial Gliomas.J Neuropathol Exp Neurol,2005,64:479-489.
126.江涛,王忠诚.构建胶质瘤综合治疗体系.河北医药,2007,29:3-6.
127.Hirko Ohgaki.Population-Based Studies on Incidence,Survival Rates,and Genetic Alterations in Astrocytic and Oligodendroglial Gliomas.J Neuropathol Exp Neurol,2005,64:479-489.