Marco Pileggi1, Elisa Ventura2, Alberto Di Napoli3, Renato Piantanida4, Mario Muto5, Andrea Cardia6, Alessandro Cianfoni2,7. 1. Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6900, Lugano, Switzerland. marco.pileggi@gmail.com. 2. Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6900, Lugano, Switzerland. 3. NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, "Sapienza" University, Rome, Italy. 4. Department of Otolaryngology-Head and Neck Surgery, Ospedale Regionale Di Lugano, EOC, Lugano, Switzerland. 5. Department of High Technology, Service and Diagnostic Imaging, Cardarelli Hospital, Naples, Italy. 6. Department of Neurosurgery, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland. 7. Department of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital, University of Bern, Bern, Switzerland.
Abstract
PURPOSE: CT-guided percutaneous procedures involving the skull base and atlanto-axial cervical spine pose particular challenges due to high density of vital vascular and nervous structures and because the ideal needle trajectory often has a cranio-caudal obliquity different from the axial scan plane. We describe how the variable CT gantry tilt, combined with gantry-needle-target alignment technique, is used to obtain precise and safe needle placement in conventional and non-conventional approaches to the skull base and the atlanto-axial spine. METHODS: We retrospectively analyzed consecutive CT-guided needle accesses to the skull base and atlanto-axial spine performed for tissue sampling through fine-needle aspirates and core biopsies, cementoplasty of neoplastic lytic lesions of atlanto-axial spine, pain management injections, and dural puncture for cerebro-spinal fluid sampling. All the accesses were performed with the gantry-needle-target alignment technique. Procedural complications were recorded. RESULTS: Thirty-nine CT-guided procedures were analyzed. Paramaxillary approach was used in 15 cases, postero-lateral in 11, subzygomatic in 3. Nine non-conventional approach were performed: submastoid in 3 cases, suprazygomatic in 2, trans-nasal in 2, trans-mastoid in 1, and trans-auricular in 1. Two peri-procedural complications occurred: one asymptomatic and one resolved within 24 h. All the procedures were successfully completed with successful needle access to the target. CONCLUSION: The gantry tilt and gantry-needle-target alignment technique allows to obtain double-oblique needle accesses for CT-guided procedures involving the skull base and atlanto-axial cervical spine, minimizing uncertainty of needle trajectory and obtaining safe needle placement in conventional and non-conventional approaches.
PURPOSE: CT-guided percutaneous procedures involving the skull base and atlanto-axial cervical spine pose particular challenges due to high density of vital vascular and nervous structures and because the ideal needle trajectory often has a cranio-caudal obliquity different from the axial scan plane. We describe how the variable CT gantry tilt, combined with gantry-needle-target alignment technique, is used to obtain precise and safe needle placement in conventional and non-conventional approaches to the skull base and the atlanto-axial spine. METHODS: We retrospectively analyzed consecutive CT-guided needle accesses to the skull base and atlanto-axial spine performed for tissue sampling through fine-needle aspirates and core biopsies, cementoplasty of neoplastic lytic lesions of atlanto-axial spine, pain management injections, and dural puncture for cerebro-spinal fluid sampling. All the accesses were performed with the gantry-needle-target alignment technique. Procedural complications were recorded. RESULTS: Thirty-nine CT-guided procedures were analyzed. Paramaxillary approach was used in 15 cases, postero-lateral in 11, subzygomatic in 3. Nine non-conventional approach were performed: submastoid in 3 cases, suprazygomatic in 2, trans-nasal in 2, trans-mastoid in 1, and trans-auricular in 1. Two peri-procedural complications occurred: one asymptomatic and one resolved within 24 h. All the procedures were successfully completed with successful needle access to the target. CONCLUSION: The gantry tilt and gantry-needle-target alignment technique allows to obtain double-oblique needle accesses for CT-guided procedures involving the skull base and atlanto-axial cervical spine, minimizing uncertainty of needle trajectory and obtaining safe needle placement in conventional and non-conventional approaches.
Authors: Sanjay Gupta; Joy A Henningsen; Michael J Wallace; David C Madoff; Frank A Morello; Kamran Ahrar; Ravi Murthy; Marshall E Hicks Journal: Radiographics Date: 2007 Mar-Apr Impact factor: 5.333