Dotter Interventional Institute, Oregon Health & Science University, Portland, OR, USA.
J Neurointerv Surg. 2011 Jun;3(2):186-90. doi: 10.1136/jnis.2010.003376. Epub 2010 Dec 16.
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.
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.
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.
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.
准确的直接穿刺入路对于头颈部血管畸形和肿瘤的成功栓塞治疗和避免并发症至关重要。本项目的主要重点是评估使用集成的 3D 锥形束 CT 和透视引导对头颈部血管畸形和肿瘤进行穿刺的准确性和易用性,并确定其对病变治疗的贡献。
本研究共纳入 27 例患者,其中女性 14 例,男性 13 例,年龄 4-63 岁。病变包括 11 例静脉畸形、5 例动静脉畸形、5 例青少年鼻咽血管纤维瘤、2 例淋巴静脉畸形、1 例淋巴管畸形、1 例毛细血管畸形、1 例鼻腔平滑肌瘤和 1 例硬脑膜动静脉瘘。共在 33 例手术中进行了 65 次针放置,使用集成的 3D 锥形束 CT 和透视引导系统。
在 65 次计划的针放置中,有 62 次通过单次穿刺成功到达浅表位置(24 次位于咽喉、咽后、梨状窦或气管旁间隙,21 次通过经鼻入路到达蝶窦和上鼻腔,5 次位于眼眶内,4 次位于喉内,4 次位于翼腭窝,1 次位于外耳道,1 次通过颅下颅骨钻孔进入颅内)。在获得针放置后锥形束 CT 的 8 例患者的 11 个部位中,针放置位置距离计划靶标在 2mm 以内。
这种集成的 3D 锥形束 CT 和透视引导系统允许在大多数情况下通过单次针穿刺轻松进入深部、难以到达的位置,从而提高了治疗效果,同时减少了手术时间。