CT-Guided Percutaneous Lateral Suprazygomatic Approach for Posterior Orbital Wall Biopsy

Abstract

A 72-year-old male with a past medical history of prostate cancer presented with progressive deterioration of vision involving the left eye. He noted a complete loss of vision in the left eye over a 3-month period. CT examination revealed a large mass encroaching on the optic nerve within the left orbital apex. This expansile, lytic lesion involved the greater wing of the sphenoid bone and was associated with a moderately enhancing soft-tissue component.The patient was referred for CT-guided biopsy of the lesion. The patient was placed in the supine position in the CT scanner. The head was stabilized with a head-holder, and the patient was given intravenous sedation and analgesia (25 mg promethazine, 3 mg diazepam, and 25 mcg fentanyl). Contrast-enhanced CT of the orbits was performed utilizing continuous 3-mm thick axial slices at 3-mm intervals to localize the lesion. In addition to showing the enhancing portions of the lesion, the use of contrast outlines all superficial and deep vascular structures that are to be avoided during the biopsy procedure; in particular, the superficial temporal artery. We then placed markers on the left temporal side of the patient's head. The markers consisted of three 18 gauge needles taped 1 inch apart prior to obtaining axial images (Fig. IA). We chose the marker closest to the lesion and positioned the table above the level of the zygoma. The skin biopsy site was marked with ink prior to sterile prepping and draping.One percent lidocaine local anesthesia was placed at the skin site. A 22-ga 3.5-inch-long spinal needle was placed initially as a reference mark and to generate a tract. Appropriate positioning of this needle was verified with CT.

Ultrasound‐guided core needle biopsy in salivary glands: A meta‐analysis

“…Core needle biopsies are widely used in many oncological diagnostic approaches as an effective alternative to open biopsy . Fine‐needle aspiration (FNA) is often performed to confirm the status of malignancy cytologically and requires experienced cytologists and practitioners .…”

“…1 Core needle biopsies are widely used in many oncological diagnostic approaches as an effective alternative to open biopsy. 2,3 Fine-needle aspiration (FNA) is often performed to confirm the status of malignancy cytologically and requires experienced cytologists and practitioners. 2 Whereas FNA biopsy is cytological, core needle biopsy obtains an adequate tissue sample for histological evaluation of architecture, which allows tumor grading and classification of malignant and benign tumors.…”

Automated tru-cut imaging-guided core needle biopsy of canine orbital neoplasia. A prospective feasibility study

“…In contrast to fine needle aspiration biopsy, which is cytological, the aim of imaging-guided core needle biopsy is to obtain adequate tissue sample for histological diagnosis. Core needle biopsies are widely used in many oncological subspecialties as an effective alternative to open biopsy (Ortiz et al, 1996;Boland et al, 2013;Finger, 2014;Héran et al, 2014). Many recent studies, in human literature, report advantages of core biopsy over fine needle aspiration biopsy as oncological diagnostic procedure (Woodcock and Morgan, 1998;Orlandi et al, 2013).…”

Tumores primários da órbita incomuns diagnosticados por biópsia com agulha grossa guiada por tomografia computadorizada: relato de dois casos

“…In a study developed by Gupta et al ( 7 ) , evaluating 37 US-guided FNABs of orbital tumors, the samples were insufficient for the diagnosis in 22% of cases. However, few reports in the literature report the use of CT-guided core biopsy for the diagnosis of orbital lesions ( 8 , 10 ) .…”