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

• Published in: Neuroradiology 2022-10, Vol.64 (10), p.2039-2047
• Main Authors: Pileggi, Marco, Ventura, Elisa, Di Napoli, Alberto, Piantanida, Renato, Muto, Mario, Cardia, Andrea, Cianfoni, Alessandro
• Format: Article
• Language: English
• Subjects: Access control; Alignment; Biopsy; Cerebrospinal fluid; Complications; Imaging; Interventional Neuroradiology; Lasers; Medical imaging; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Pain; Placement; Radiology; Sampling; Skull; Spine; Spine (cervical)
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-022-03005-9

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.