Percutaneous CT-Guided Biopsy of the Craniovertebral Junction: Safety, Diagnostic Yield, and Technical Notes

Abstract

The craniovertebral junction defined as the occiput, the atlas, and the axis is a complex bony region that contains vital neural and vascular structures. We report the experience of a single academic institution regarding CT-guided biopsy of this skeletal region. We reviewed all of the CT-guided biopsies performed in our department, completed in the craniovertebral junction. We collected data in regard to biopsy procedures, patients’ vital statistics, and histopathological diagnosis. In total, 16 patients (8M and 8F; mean age 52; range 16–86 years old) were included in this series. In eight patients, the lesions were located in the atlas vertebra (8/16—50%), in six patients in the axis (37.5%), and in two patients in the occiput (12.5%). No complications were observed during or after the procedures. All of the procedures were technically successful. The biopsy was diagnostic in 13/16 patients (81.3%): four metastatic lesions (25%—three breast and one prostate cancers), four multiple myeloma bone lesions (25%), three aneurismal bone cysts (18.8%), one aggressive hemangioma (6.3%), and one pseudogout (6.3%). Moreover, in two-thirds (66.6%) of non-diagnostic histological reports, malignancies were excluded. CT-guided percutaneous biopsy is a safe tool and allows obtaining a histological diagnosis, in most cases, even in the most delicate site of the human skeleton—the craniovertebral junction.

Percutaneous CT-Guided Bone Biopsies: Indications, Feasibility and Diagnostic Yield in the Different Skeletal Sites—From the Skull to the Toe

“…CT guidance, with the aid of intravenous contrast media injection for the visualization of vertebral arteries if necessary, has been proven to be feasible and safe even in this complex skeletal region (Figure 4). Spinnato et al in 2022 reported the feasibility and safety of CT-guided bone biopsies performed in the craniovertebral junction of 16 patients, with a diagnostic accuracy of 81.3% [28]. In this series, the needle approach was always posterior or lateral, but it is well known that in peculiar atlantoaxial spinal locations (e.g., dens of the atlas), an anterior open-mouth approach through the oropharyngeal space should be chosen [29,30].…”

“…Spinnato et al in 2022 reported the feasibility and safety of CT-guided bone biopsies performed in the craniovertebral junction of 16 patients, with a diagnostic accuracy of 81.3% [28]. In this series, the needle approach was always posterior or lateral, but it is well known that in peculiar atlantoaxial spinal locations (e.g., dens of the atlas), an anterior open-mouth approach through the oropharyngeal space should be chosen [29,30].…”

“…In this series, the needle approach was always posterior or lateral, but it is well known that in peculiar atlantoaxial spinal locations (e.g., dens of the atlas), an anterior open-mouth approach through the oropharyngeal space should be chosen [29,30]. Using a contrast media injection can help visualize vertebral arteries, aiding a safe posterior (or lateral) approach [28].…”

MRI-Based Radiomics Differentiates Skull Base Chordoma and Chondrosarcoma: A Preliminary Study

“…The anterior skull base proper is formed medially by the cribriform plate, which forms the roof of the nasal cavity; laterally, by the orbital plates of the frontal bone, which form the roof of the orbits and ethmoid air cells; and posteriorly, by the planum sphenoidale and lesser wings of the sphenoid. Percutaneous image-guided biopsy for definitive histologic diagnosis was achieved in 86% (12/14) of cases in the skull [12] and 81.3% (13/16) of cases in the craniovertebral junction [13]. However, for 'central' skull base tumors, image-guided biopsy is not safe due to the presence of the vital adjacent structures described above.…”

CT-Guided Radiofrequency Thermal Ablation for the Treatment of Atypical, Early-Onset Osteoid Osteoma in Children Younger than 4 Years Old: Single-Institution Experience and Literature Review

“…This can be useful, particularly for atypical cases. CT-guidance was demonstrated to be safe and effective for interventional procedures in almost all skeletal sites, including the riskiest and most delicate ones, such as the craniovertebral junction (C0–C3) or the skull [ 11 , 12 ].…”