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Integrated cone-beam CT and fluoroscopic navigation in treatment of head and neck vascular malformations and tumors
  1. Gary M Nesbit1,
  2. Eric G Nesbit2,
  3. Bronwyn E Hamilton3
  1. 1Dotter Interventional Institute, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Whitman University, Walla Walla, Washington, USA
  3. 3Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr Gary M Nesbit, Dotter Interventional Institute, Oregon Health & Science University, 2181 SW Sam Jackson Park Road, CR 135, Portland, OR 97239, USA; nesbitg{at}ohsu.edu

Abstract

Background and aim Accurate direct puncture access to vascular malformations and tumors of the head and neck is critical to successful embolization treatment and avoidance of complications. The primary focus of this project was to evaluate the accuracy and ease of needle placement using integrated 3D cone-beam CT and fluoroscopic guidance in accessing head and neck vascular malformations and tumors, and to determine its contribution to lesion treatment.

Methods A total of 27 patients, 14 female and 13 male, aged 4–63 years, were included in this study. The lesions included 11 venous malformations, 5 arteriovenous malformations, 5 juvenile nasopharyngeal angiofibromas, 2 lymphovenous malformations, 1 lymphatic malformation, 1 capillary malformation, 1 nasal cavity leiomyoma, and 1 dural arteriovenous fistula. A total of 65 needle placements in 33 procedures were performed using an integrated 3D cone-beam CT and fluoroscopic guidance system.

Results Targeting was successful with a single pass in 62 of 65 planned needle placements to a superficial location in 24, the hypopharynx, retro-pharyngeal, pyriform sinus, or paratracheal spaces in 21, the sphenoid sinus and upper nasal cavity via trans-nasal approach in 5, intra-orbital in 5, intra-laryngeal in 4, pterygo-palatine fossa in 4, external auditory canal in 1, and intracranial via a juxta-torcular burr hole in 1. Needle placement was within 2 mm of the planned target in 11 locations in the 8 patients where post needle-placement cone-beam CT was obtained.

Conclusion This integrated 3D cone-beam CT and fluoroscopic guidance allowed access to deep, difficult to access, locations with ease using a single needle pass in most cases, resulting in improved treatment with decreased procedure times.

  • Neck
  • Malformation
  • Tumor
  • CT
  • Navigation

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Oregon Health & Science University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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