Gantry-needle-target alignment technique for CT-guided needle approaches to the skull base and cranio-cervical junction.

Pileggi, Marco; Ventura, Elisa; Di Napoli, Alberto; Piantanida, Renato; Muto, Mario; Cardia, Andrea; Cianfoni, Alessandro (2022). Gantry-needle-target alignment technique for CT-guided needle approaches to the skull base and cranio-cervical junction. Neuroradiology, 64(10), pp. 2039-2047. Springer-Verlag 10.1007/s00234-022-03005-9

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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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5 Citations in Web of Science ®
6 Citations in Scopus

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