Abstract
We assess the theoretical feasibility of percutaneous posterior sacral foramen (pSF) needle puncture of the sacral dural sac (DS) by studying the three-dimensional imaging anatomy of pSFs relative to the sacral canal (SC). On CT images of 40 healthy subjects, we retrospectively studied sacral alae passageways from SC to pSFs in all three planes to determine if an imaginary spinal needle could theoretically traverse S1 or S2 pSFs in a straight path toward DS. If not straight, we measured multiplane angulations and morphometrics of this route. We found no straight connections between S1 or S2 pSFs and SC. Instead, there were bilateral spatially complex dorsoventral M-shaped “foraminal conduits” (FCs; common, ventral, and dorsal) from SC to anterior SFs and pSFs that would prevent percutaneous straight needle puncture of the DS. This detailed knowledge of the sacral FCs will be useful for accurate imaging interpretation and interventional procedures on the sacrum.
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Data generated or analyzed during the study are available from the corresponding author upon reasonable request.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Siddhant S. Dhawan, Fabian N. Necker, and Tarik F. Massoud. The first draft of the manuscript was written by Siddhant S. Dhawan and Tarik F. Massoud and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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We obtained ethical approval for this research study and waiver of individual patient consent from our local institutional review board administrative panel on human subjects in medical research. This approval was obtained from the ethics committee of Stanford University School of Medicine, USA (protocol: 55014). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research.committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Stanford University School of Medicine, USA, approved this study (protocol: 55014). This included waiver of individual authorization for recruitment under title 45 CFR 164.512, pursuant to information provided in the HIPAA section of the protocol application. Consent was not required as patient information was anonymized and the publication submission does not include images that may identify the patient.
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Dhawan, S.S., Necker, F.N. & Massoud, T.F. Feasibility of percutaneous dural sac puncture via a posterior trans-sacral foraminal conduit approach: a CT morphometric analysis. Neuroradiology 65, 1555–1559 (2023). https://doi.org/10.1007/s00234-023-03147-4
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DOI: https://doi.org/10.1007/s00234-023-03147-4