title: Transnasal Endoscopic Biopsy Approach to Atlas Tumor with X-ray Assisted and Related Radiographic Measure.
abstract: OBJECTIVE
  To develop an endoscopic transnasal approach to atlas tumors and study its practicability.
  
  
  METHODS
  This article comprises two components: an illustrative case report and observational data on 50 volunteers. As to the case report, a 34 year old man presented with occipital pain for more than 3 months and underwent systematic investigation in Qilu Hospital of Shandong University. CT and MRI scans showed bony destruction in the craniovertebral junction (CVJ) suggestive of tumor. Via an endoscopic transnasal approach to the suspected atlas tumor through the inferior nasal meatus, a Gallini biopsy needle was used to obtain tissue for examination. The procedure was performed endoscopically with double orientation X-ray guidance and coaxial technology after establishing the shortest distance for the biopsy track and range of target tissue and was assisted by manual palpation. As to the observational data, 50 volunteers underwent atlas-related morphometric image measurement using gemstone CT equipment. Biopsy track angles, range for biopsy of the atlas and biopsy track distances were measured by a blinded operator on CT images.
  
  
  RESULTS
  
  
  
  METHODS
  pathological examination of the biopsy resulted in diagnosis of a chordoma. There were no complications such as bleeding, infection or spinal cord injury. One month later, the patient underwent tumor resection and reconstruction in other hospital and the diagnosis of chordoma was confirmed by pathological examination of the resected specimen. Observational data: measurements obtained from CT scans of the 50 volunteers were as follows. Biopsy track angles: mean leaning inside angle 3.53° ± 0.39° and mean posterior slope angle 13.05° ± 1.39°. Range for atlas biopsy: transverse diameter 11.84 ± 1.24 mm and longitudinal diameter 9.67 ± 0.90 mm. Biopsy track distances: from atlas to nostril, and to anterior and posterior edges of the inferior turbinate mucosa were 94.52 ± 5.03 mm, 78.21 ± 4.63 mm, and 33.51 ± 3.13 mm, respectively.
  
  
  CONCLUSIONS
  An endoscopic transnasal approach enables biopsy and diagnosis of tumors in the anterior arch of the atlas. Relevant measurements were obtained by assessing CT scans of 50 volunteers to assist operators to determine the effective and safe range for transnasal atlas biopsy.
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Zhen-Feng
authors.initials: ZF
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Xian-Hao
authors.initials: XH
authors.lastname: Shao
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Li-Qiang
authors.initials: LQ
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Li
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D001270:Cervical Atlas / Q000000981:diagnostic imaging*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009666:Nose; D013125:Spinal Neoplasms / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
keywords: Atlas; Biopsy; Endoscopy; Image measurement; Transnasal approach