Transoral approach to CT-guided C2 interventions.

BACKGROUND Lesions involving C2 are unique as it is challenging to approach these lesions. The transoral approach to C2 lesions has been extensively used by surgeons and increasingly used by interventional radiologists for vertebroplasty as it is safer and less demanding than other approaches like anterolateral and posterolateral (transpedicular). However, using this approach for image-guided biopsies is little described in literature with a few cases described so far being under fluoroscopic guidance. We describe a series of 5 procedures using transoral approach - 4 biopsies (and one vertebroplasty that was published earlier) on C2 lesions under CT guidance. To our knowledge, our series is the first one where the transoral biopsies were performed using Computed Tomography (CT) guidance. OBJECTIVE To describe our initial experience with the transoral approach to image-guided biopsies on C2 vertebra and its relative advantages and disadvantages. METHODS We performed 5 procedures - 4 biopsies (and one vertebroplasty published earlier) on different types of lesions involving C2, through the transoral approach, using CT guidance under general anesthesia and appropriate precautions to reduce potential complications like infection, hemorrhage, etc. RESULTS The procedures were well tolerated by the patients without any complications, immediately as well as at follow-up. All the biopsies in our series were technically successful without any minor or major complications. The biopsy yield was 50% which may be due to the thinner needles used. CONCLUSION CT-guided transoral approach to biopsies on C2 lesions is a direct, safe, and precise technique when performed with appropriate precautions.