title: Subarachnoid and basal cistern navigation through the sacral hiatus with guide wire assistance.
abstract: BACKGROUND
  Intraspinal navigation with catheters and fiberscopes has shown feasible results for diagnosis and treatment of intraspinal and intracranial lesions. The most common approach, lumbar puncture, has allowed access to the spinal cord, however, coming with the difficulties of fiberscope damage and decreased torque for guidance. Our objective in this study is to allow an alternate access, the sacral hiatus, with guide wire assistance into the subarachnoid and intracranial structures, while easing the angle of entry and increasing torque.
  
  
  METHODS
  We advanced catheters with guide wire and fluoroscopy assistance into the sacral hiatus of three cadavers. After entry, the thecal sac was punctured and the catheter with guide wire was advanced rostrally until positioned in the basal cisterns of the brain. We confirmed catheter placement with contrast injection, autopsy, and dissection.
  
  
  RESULTS
  In our study, the sacral hiatus was easily accessed, but resistance was found when attempting to puncture the thecal sac. The advancement of the catheter with guide wire assistance glided easily rostrally until some mild resistance was discovered at entry into the foramen magnum. With redirection, all catheters passed with ease into the basal cisterns. Positioning was confirmed with contrast injection with fluoroscopy evidence, autopsy, and dissection. There was no macroscopic or microscopic evidence of damage to the spinal roots, spinal cord, or cranial nerves.
  
  
  CONCLUSIONS
  The sacral hiatus with guide wire assistance is an accessible conduit for uncomplicated entry into the subarachnoid and basal cistern space without damaging surrounding structures.
authors.affiliation: Department of Radiology, New York University, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Layer
authors.forename: Roy
authors.initials: R
authors.lastname: Riascos
authors.forename: Farhood
authors.initials: F
authors.lastname: Firouzbakht
authors.forename: Adewumi
authors.initials: A
authors.lastname: Amole
authors.forename: Rudiger
authors.initials: R
authors.lastname: Von Ritschl
authors.forename: Pier
authors.initials: P
authors.lastname: Dipatre
authors.forename: Hugo
authors.initials: H
authors.lastname: Cuellar
mesh_terms: D001864:Bone Wires; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging*; D013115:Spinal Canal / Q000000981:diagnostic imaging*; D013346:Subarachnoid Space / Q000000981:diagnostic imaging