OBJECTIVEIntraoperative angiography can be a valuable tool in the surgical management of vascular disorders in the CNS. This is typically accomplished via femoral artery puncture; however, this can be technically difficult in patients in the prone position. The authors describe the feasibility of intraoperative angiography via the popliteal artery in the prone patient.METHODSThree patients underwent intraoperative spinal angiography in the prone position via vascular access through the popliteal artery. Standard angiography techniques were used, along with ultrasound and a micropuncture needle for initial vascular access. Two patients underwent intraoperative angiography to confirm the obliteration of dural arteriovenous fistulas. The third patient required unexpected intraoperative angiography when a tumor was concerning for a vascular malformation in the cervical spine.RESULTSAll 3 patients tolerated the procedure without complication. The popliteal artery was easily accessed without any adaptation to typical patient positioning for these prone-position cases. This proved particularly beneficial when angiography was not part of the preoperative plan.CONCLUSIONSIntraoperative angiography via the popliteal artery is feasible and well tolerated. It presents significant benefit when obtaining imaging studies in patients in a prone position, with the added benefit of easy access, familiar anatomy, and low concern for catheter thrombosis or kinking.

While several studies have assessed the efficacy of adrenal fine-needle aspiration, there are few data regarding adrenal tissue core biopsies. We performed a retrospective study, for a 12-year period, of 204 percutaneous adrenal core biopsy specimens. A core was the only specimen obtained, and on-site evaluation was not used. About half of the cases (104/204) were diagnosed as metastatic carcinoma, with lung as the most common origin (78/204). A specificity and sensitivity of 100% for benign vs malignant was calculated, with a specificity of 88% and sensitivity of 86% for specific diagnoses. Diagnostic and sampling errors were identified. False-negatives were limited to biopsies using 20-gauge needles. Cases with a clinical history provided had specific diagnoses made at a slightly higher frequency compared with cases without an available history. Immunohistochemical workup was performed in more than half of the cases; specific diagnoses were made more frequently than in cases without immunostains.

Denosumab has demonstrated anti-GCT efficacy. In combination with proton therapy, it has the potential to spare a young, vulnerable population from adverse long-term effects of traditional adjuvant radiation therapy. To our knowledge, this is the first report of the use of denosumab in the treatment of GCT of the clivus in the United States.