title: Preoperative localization of spinal and peripheral pathologies for surgery by computed tomography-guided placement of a specialized needle system.
abstract: OBJECTIVE
  Exact intraoperative localization of pathologies in spinal and peripheral nerve surgery is not easily achieved. In spinal surgery, intraoperative fluoroscopy is the common method for identification of the level affected. It seldom visualizes the pathology itself and is prone to error in identifying anatomic disorders and superimposing structures. In peripheral nerve surgery, intraoperative fluoroscopy is of little value. The present technical study was conducted to evaluate the feasibility of using a preoperative computed tomography-guided needle marking system, which was previously developed for use in gynecology. The goal was to reduce intraoperative localization error and radiation exposure to patients and operating room personnel.
  
  
  METHODS
  We used a flexible hooked-wire needle marking system, which has previously been used for preoperative marking of breast lesions, to localize and tag spinal and peripheral nerve pathologies. Marking was carried out under computed tomographic control before surgery. Seven illustrative cases were chosen for this report: 6 patients with disorders of the spine and 1 patient with a peripheral nerve schwannoma.
  
  
  RESULTS
  No adverse reactions, aside from minor discomfort, were observed in this study. In all cases, the needle could be used as a reliable guide for the surgical approach and led directly to the pathology. In no case was additional intraoperative fluoroscopy needed. The level of radiation exposure to the patient as a result of computed tomography-based marking was similar to or less than that encountered in conventional intraoperative x-ray localization. Radiation exposure to the operating room personnel was eliminated by this method.
  
  
  CONCLUSIONS
  Preoperative marking of spinal level or peripheral nerve pathologies with a flexible hooked-wire needle marking system is feasible and appears to be safe and useful for neurosurgical spinal and peripheral procedures.
authors.affiliation: Neurosurgery Clinic, Heinrich-Heine University, Düsseldorf, Germany. philipp.slotty@med.uni-duesseldorf.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Slotty
authors.forename: Patrick
authors.initials: P
authors.lastname: Kröpil
authors.forename: Mark
authors.initials: M
authors.lastname: Klingenhöfer
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D016543:Central Nervous System Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods; D010525:Peripheral Nerves / Q000473:pathology*; D011300:Preoperative Care / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000473:pathology*; D025321:Surgery, Computer-Assisted / Q000379:methods*