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.
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References
Eckel TS, Bartynski WS (2009) Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol 12:11–21. https://doi.org/10.1053/j.tvir.2009.06.004
Falco F (2009) Systematic review of diagnostic utility and therapeutic effectiveness of cervical facet joint interventions. Pain Phys 2(12):323–344. https://doi.org/10.36076/ppj.2009/12/323
Anselmetti GC, Bonaldi G, Carpeggiani P et al (2011) Vertebral Augmentation: 7 Years Experience. In: Alexandre A, Masini M, Menchetti PPM (eds) Advances in minimally invasive surgery and therapy for spine and nerves. Springer, Vienna, pp 147–61. https://doi.org/10.1007/978-3-211-99370-5_23
Gangi A, Tsoumakidou G, Buy X et al (2011) Percutaneous techniques for cervical pain of discal origin. Semin Musculoskelet Radiol 15:172–180. https://doi.org/10.1055/s-0031-1275601
Van Zundert J, Vanelderen P, Kessels A et al (2012) Radiofrequency treatment of facet-related pain: evidence and controversies. Curr Pain Headache Rep 16:19–25. https://doi.org/10.1007/s11916-011-0237-8
Kranz PG, Raduazo P, Gray L et al (2012) CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters. AJNR Am J Neuroradiol 33:1221–1224. https://doi.org/10.3174/ajnr.A2954
Gandhi D, Gemmete JJ, Ansari SA et al (2008) Interventional neuroradiology of the head and neck. AJNR Am J Neuroradiol 29:1806–1815. https://doi.org/10.3174/ajnr.A1211
Boulter DJ, Rumboldt Z, Bonaldi G et al (2014) Tilting the gantry for CT-guided spine procedures. Radiol med 119:750–757. https://doi.org/10.1007/s11547-013-0344-1
Ortiz O, Bastug D, Ellis B (1996) CT-guided percutaneous lateral suprazygomatic approach for posterior orbital wall biopsy. Skull Base 6:249–251. https://doi.org/10.1055/s-2008-1058633
Abrahams JJ (1998) Mandibular sigmoid notch: a window for CT-guided biopsies of lesions in the peripharyngeal and skull base regions. Radiology 208:695–699. https://doi.org/10.1148/radiology.208.3.9722848
Gupta S, Henningsen JA, Wallace MJ et al (2007) Percutaneous biopsy of head and neck lesions with CT guidance: various approaches and relevant anatomic and technical considerations. Radiographics 27:371–390. https://doi.org/10.1148/rg.272065101
Connor SEJ, Chaudhary N (2008) CT-guided percutaneous core biopsy of deep face and skull-base lesions. Clin Radiol 63:986–994. https://doi.org/10.1016/j.crad.2008.04.013
Cianfoni A, Distefano D, Chin SH et al (2012) Percutaneous cement augmentation of a lytic lesion of C1 via posterolateral approach under CT guidance. Spine J 12:500–506. https://doi.org/10.1016/j.spinee.2012.05.012
Massari F, Rumboldt Z, Vandergrift W et al (2014) Percutaneous image-guided C-spine procedures. Neurograph 4:62–77. https://doi.org/10.3174/ng.2140079
McKnight CD, Glastonbury CM, Ibrahim M et al (2017) Techniques and approaches for safe, high-yield CT-guided suprahyoid head and neck biopsies. Am J Roentgenol 208:76–83. https://doi.org/10.2214/AJR.16.16558
Wu E-H, Chen Y-L, Toh C-H et al (2013) CT-guided core needle biopsy of deep suprahyoid head and neck lesions in untreated patients. Interv Neuroradiol 19:365–369. https://doi.org/10.1177/159101991301900315
Caldemeyer KS, Pritz MB (1999) CT-guided percutaneous fine-needle aspiration biopsy of posterior skull base lesions. Skull Base 9:161–165. https://doi.org/10.1055/s-2008-1058164
DelGaudio JM, Dillard DG, Albritton FD et al (2000) Computed tomography–guided needle biopsy of head and neck lesions. ARCH OTOLARYNGOL HEAD NECK SURG 126:5
Okuda Y (2000) Use of computed tomography for maxillary nerve block in the treatment of trigeminal neuralgia. Reg Anesth Pain Med 25:417–419. https://doi.org/10.1053/rapm.2000.6447
Wu E-H, Chen Y-L, Wu Y-M et al (2013) CT-guided core needle biopsy of deep suprahyoid head and neck lesions. Korean J Radiol 14:299. https://doi.org/10.3348/kjr.2013.14.2.299
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Conception or design of the work: Alessandro Cianfoni. Acquisition, analysis, and interpretation of data: Marco Pileggi and Alessandro Cianfoni. Drafting the work: Marco Pileggi and Alessandro Cianfoni. Final approval of the version to be published: all authors.
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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The local ethical committee (“Ethics Committee of Canton Ticino”) waived approval for this retrospective study.
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Andrea Cardia and Alessandro Cianfoni request joint last co-authorship.
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Pileggi, M., Ventura, E., Di Napoli, A. et al. Gantry-needle-target alignment technique for CT-guided needle approaches to the skull base and cranio-cervical junction. Neuroradiology 64, 2039–2047 (2022). https://doi.org/10.1007/s00234-022-03005-9
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DOI: https://doi.org/10.1007/s00234-022-03005-9