BACKGROUND AND AIM: Accurate direct puncture access to vascular malformations and tumors of the head and neck is critical to successful embolization treatment and avoidance of complications. The primary focus of this project was to evaluate the accuracy and ease of needle placement using integrated 3D cone-beam CT and fluoroscopic guidance in accessing head and neck vascular malformations and tumors, and to determine its contribution to lesion treatment. METHODS: A total of 27 patients, 14 female and 13 male, aged 4-63 years, were included in this study. The lesions included 11 venous malformations, 5 arteriovenous malformations, 5 juvenile nasopharyngeal angiofibromas, 2 lymphovenous malformations, 1 lymphatic malformation, 1 capillary malformation, 1 nasal cavity leiomyoma, and 1 dural arteriovenous fistula. A total of 65 needle placements in 33 procedures were performed using an integrated 3D cone-beam CT and fluoroscopic guidance system. RESULTS: Targeting was successful with a single pass in 62 of 65 planned needle placements to a superficial location in 24, the hypopharynx, retro-pharyngeal, pyriform sinus, or paratracheal spaces in 21, the sphenoid sinus and upper nasal cavity via trans-nasal approach in 5, intra-orbital in 5, intra-laryngeal in 4, pterygo-palatine fossa in 4, external auditory canal in 1, and intracranial via a juxta-torcular burr hole in 1. Needle placement was within 2 mm of the planned target in 11 locations in the 8 patients where post needle-placement cone-beam CT was obtained. CONCLUSION: This integrated 3D cone-beam CT and fluoroscopic guidance allowed access to deep, difficult to access, locations with ease using a single needle pass in most cases, resulting in improved treatment with decreased procedure times.
BACKGROUND AND AIM: Accurate direct puncture access to vascular malformations and tumors of the head and neck is critical to successful embolization treatment and avoidance of complications. The primary focus of this project was to evaluate the accuracy and ease of needle placement using integrated 3D cone-beam CT and fluoroscopic guidance in accessing head and neck vascular malformations and tumors, and to determine its contribution to lesion treatment. METHODS: A total of 27 patients, 14 female and 13 male, aged 4-63 years, were included in this study. The lesions included 11 venous malformations, 5 arteriovenous malformations, 5 juvenile nasopharyngeal angiofibromas, 2 lymphovenous malformations, 1 lymphatic malformation, 1 capillary malformation, 1 nasal cavity leiomyoma, and 1 dural arteriovenous fistula. A total of 65 needle placements in 33 procedures were performed using an integrated 3D cone-beam CT and fluoroscopic guidance system. RESULTS: Targeting was successful with a single pass in 62 of 65 planned needle placements to a superficial location in 24, the hypopharynx, retro-pharyngeal, pyriform sinus, or paratracheal spaces in 21, the sphenoid sinus and upper nasal cavity via trans-nasal approach in 5, intra-orbital in 5, intra-laryngeal in 4, pterygo-palatine fossa in 4, external auditory canal in 1, and intracranial via a juxta-torcular burr hole in 1. Needle placement was within 2 mm of the planned target in 11 locations in the 8 patients where post needle-placement cone-beam CT was obtained. CONCLUSION: This integrated 3D cone-beam CT and fluoroscopic guidance allowed access to deep, difficult to access, locations with ease using a single needle pass in most cases, resulting in improved treatment with decreased procedure times.
Authors: Daniel L Cooke; Michael R Levitt; Louis J Kim; Danial K Hallam; Laligam N Sekhar; Basavaraj V Ghodke Journal: Int J Comput Assist Radiol Surg Date: 2015-08-05 Impact factor: 2.924
Authors: W M H Busser; S J Braak; J J Fütterer; M J L van Strijen; Y L Hoogeveen; F de Lange; L J Schultze Kool Journal: Br J Radiol Date: 2013-08-02 Impact factor: 3.039
Authors: Marc C Mabray; Sanjit Datta; Prasheel V Lillaney; Teri Moore; Sonja Gehrisch; Jason F Talbott; Michael R Levitt; Basavaraj V Ghodke; Paul S Larson; Daniel L Cooke Journal: J Neurointerv Surg Date: 2015-06-05 Impact factor: 5.836
Authors: Marius Schwalbe; Axel Haine; Marc Schindewolf; Hendrik von Tengg-Kobligk; Tom Williamson; Stefan Weber; Iris Baumgartner; Torsten Fuss Journal: Int J Comput Assist Radiol Surg Date: 2016-05-27 Impact factor: 2.924