Purpose
Percutaneous punctures in the head and neck region are traditionally guided using either static CT images, CT fluoroscopy or X-ray fluoroscopy. All mentioned approaches posses their limitations; Both CT based procedures are limited by the patient access area within the gantry. Also the needle path, which can be planned and tracked, is restricted to the axial planes that are imaged by the CT modality. Static CT images further lack the real time feedback. X-ray fluoroscopy generates less X-ray dose, compared to CT fluoroscopy, and offers...
Methods and Materials
Before the puncture is performed, the optimal needle paths are planned on the morphological data set. This can be a pre-operative CT dataset, or a rotational soft-tissue reconstruction, acquired with the C-arm system (XperCT dataset). Within the anatomy of interest a target point is selected (mid point of the lesion location, see figures 1-3). Then a 3D view showing unobstructed access to the target, avoiding the impenetrable bones and major vessels, determines the incision entry point, see figure 4. After the target and the entry...
Results
The proposed method has been applied to navigate a needle along 8 planned paths to puncture a glomus jugulare tumor for two patients. It has been previously shown that the percutaneous intratumoral injection of cyanoacrylate is an effective approach to embolize head and neck paragangliomas [Giansante Abud et al.]. For both patients two needle trajectories have been planned, using a pre-operative CT. The registration [Maes et al.] with the peri-operative XperCT reconstruction took less than 8 seconds. Using the described XperGuide method, it proved to...
Conclusions
The fluoroscopy navigation, overlaid with the planned path, has been shown to be an accurate tool for needle guidance. The procedure could be performed in the angio lab, using C-arm fluoroscopy. No additional navigation equipment or special devices were required. The procedure could be performed very efficiently, compared to CT guidance. The patient orientation differed between the pre-operative CT and the fluoroscopy guided intervention, but this did not form a complicating factor. The needle accessibility of an intracranial location, however, can be limited persé by...
