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. 2022 Oct;64(10):2039-2047.
doi: 10.1007/s00234-022-03005-9. Epub 2022 Jul 5.

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

Marco Pileggi  1 , Elisa Ventura  2 , Alberto Di Napoli  3 , Renato Piantanida  4 , Mario Muto  5 , Andrea Cardia  6 , Alessandro Cianfoni  2   7
Affiliations

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

Marco Pileggi et al. Neuroradiology. 2022 Oct.

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.

Keywords: CT-guided interventions; Skull base.

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