Department of Diagnostic and Interventional Neuroradiology, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6900, Lugano, Switzerland.
NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, "Sapienza" University, Rome, Italy.
Neuroradiology. 2022 Oct;64(10):2039-2047. doi: 10.1007/s00234-022-03005-9. Epub 2022 Jul 5.
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.
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.
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.
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.
由于颅底和寰枢颈椎血管和神经结构密集，理想的针道往往与轴向扫描平面有不同的颅尾斜度，因此 CT 引导下经颅底和寰枢颈椎的经皮操作具有特殊的挑战性。我们描述了如何结合可变 CT 机架倾斜和机架-针-靶对准技术，以获得常规和非常规颅底和寰枢颈椎进针的精确和安全。
我们回顾性分析了连续的 CT 引导下经颅底和寰枢颈椎的针道穿刺，这些穿刺是为了通过细针抽吸和核心活检进行组织取样、对肿瘤性溶骨性寰枢颈椎病变进行骨水泥成形术、疼痛管理注射以及硬脑膜穿刺以获取脑脊液样本。所有的穿刺都是用机架-针-靶对准技术进行的。记录了程序并发症。
分析了 39 例 CT 引导下的操作。15 例采用下颌后入路，11 例采用后外侧入路，3 例采用下颌下入路。进行了 9 例非传统入路：3 例经乳突下入路，2 例经颧下入路，2 例经鼻下入路，1 例经乳突下入路，1 例经耳下入路。2 例发生围手术期并发症：1 例无症状，1 例在 24 小时内解决。所有的操作都成功完成，针道成功到达了目标。
机架倾斜和机架-针-靶对准技术允许对颅底和寰枢颈椎的 CT 引导操作进行双斜进针，最大限度地减少针道的不确定性，并在常规和非常规入路中获得安全的针道放置。
