With the advancement of modern neuroimaging and neuronavigation techniques, frameless intracranial biopsy techniques have been increasingly used.
To assess the application value of a neuronavigation system using 3.0T magnetic resonance imaging (MRI) in frameless stereotactic brain biopsies.
Twenty-seven patients with intracranial lesions were recruited in the Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region from March 2018 to June 2021. All of them underwent brain MRI at 3.0T, then registered for using the Medtronic Stealth Station S7 neuronavigation system to implement frameless stereotactic brain biopsies. Pre-biopsy data, post-biopsy complications and pathological diagnosis rate were reviewed retrospectively.
In all, 27 biopsies were performed in these 27 cases, among which anaplastic astrocytoma and large B-cell lymphoma accounted for 33.3% (9/27) , and 18.5% (5/27) , respectively. Twenty-six cases obtained a definite diagnosis by frameless stereotactic brain biopsies, with a rate of pathological diagnosis of 96.3%. During the brain biopsy, puncture tract bleeding occurred in two cases (7.4%) , and one of them was confirmed with serious bleeding by post-biopsy brain CT. Five cases had post-biopsy complications (18.5%) , four of them had intracranial hemorrhage (14.8%) , and the other one case had pulmonary infection (3.7%) . No death occurred in the biopsy.
This kind of frameless stereotactic brain biopsy is safe and effective with a high diagnostic rate.
Fetal arteriovenous malformations may occur in all parts of the body and are mainly diagnosed by color Doppler ultrasound. However, there are few reports at home and abroad on the types of arteriovenous shunts explored by prenatal ultrasound.
To investigate the diagnosis value of prenatal ultrasonography in fetal arteriovenous malformation.
Pregnant women with fetal arteriovenous malformations who underwent prenatal ultrasound screening in the Department of Ultrasound, Changsha Hospital for Maternal and Child Health Care from August 2013 to August 2021 were recruited. Color Doppler ultrasonography was used for fetal systematical ultrasound screening. The location, size, shape, and internal echoes of fetal arteriovenous malformation lesions were detected and described. The ultrasonographic features and types of arteriovenous malformations in different parts of patients were analyzed, and the results of follow-up were tracked.
Prenatal ultrasound screening in this study identified sixteen cases with fetal arteriovenous malformations, of which six lesions were located in the fetal sacrococcygeal region (diagnosed as sacrococcygeal teratoma) , four were located in the fetal intracranial region (including three intracranial cranberg hemangiomas with Galen's vein tumors, one Galen's vein tumor) , three were located in the fetal limbs, soft tissues (including one Parkes Weber syndrome, two soft tissue hemangiomas) , two were located in fetal liver (diagnosed as hepatic arteriovenous fistula) and one was located in fetal lung (diagnosed as isolated lung with pulmonary arteriovenous fistula) . Arteriovenous malformation typing: 10 patients had simple type Ⅱ (10/16) , 3 patients had both type Ⅱ and type Ⅲa (3/16) , 1 patient had type Ⅰ (1/16) , 1 patient had type Ⅳ (1/16) , 1 patient had simple type Ⅲa (1/16) . Follow up showed that 10 induced labor, 3 were lost to follow-up, 2 were born at term and treated surgically, and 1 was stillborn.
The prognosis of fetal arteriovenous malformation is closely related to the location of lesion and blood flow distribution within the lesion. Prenatal ultrasound can detect a fetus with or without a focus of arteriovenous malformation, which is valuable for diagnosis and prognosis, and can help to detect the potential threat caused by arteriovenous malformation to the fetus.
Insulinoma is a common functional pancreatic neuroendocrine tumor, with high possibility of being misdiagnosed due to complex and changeable symptoms. Making a topical diagnosis and providing patients with the optimal treatment are major challenges in the diagnosis and treatment of insulinoma.
To give a summary of our experience of diagnosis and treatment of insulinoma.
A retrospective design was used. Participants were 15 insulinoma patients who received surgical treatment in Affiliated Hospital of Chengde Medical University from 2009 to 2019. Their clinical data (including clinical presentations, qualitative diagnosis, topical diagnosis, surgical approach, and postoperative conditions) , and follow-up data were summarized.
Thirteen patients had solitary insulinoma, 2 patients had multiple insulinomas. One patient with multiple insulinomas also had multiple neuroendocrine tumor type 1 (MEN-1) . All cases showed Whipple's triad, with an insulin release index (IRI/G) greater than 0.3. All patients had negative results for transabdominal ultrasonography. Fourteen patients had positive results for enhanced pancreatic CT, and the other one with negative results was found with insulinoma by MRI. All patients underwent surgical resection, among whom 9 underwent insulinoma enucleation, 5 underwent a distal pancreatectomy (4 used laparoscopic approach and 1 used open approach) , the MEN-1 patient underwent pylorus-preserving pancreaticoduodenectomy (PPPD) plus distal pancreatectomy. All tumors were pathologically benign. There were 4 cases of postoperative clinically relevant pancreatic fistula (grade B/C) , and there was no perioperative death. Hypoglycemia disappeared after resection in all cases, and no recurrence and new-onset diabetes were found in the follow-up.
Whipple's triad and IRI/G are the main evidence for qualitative diagnosis preoperatively. Contrast-enhanced CT and MRI of the pancreas are the first-line preoperative diagnostic methods, and endoscopic ultrasound is an important supplementary method. Surgical resection is the first-line treatment, and enucleation should be preferred for eligible patients in order to fully preserving pancreatic exocrine and endocrine functions.
