The Oblique Puncture Approach Via Anterolateral To C2: A Study Of Imaging Anatomy On Corpses

Objective To determine the anatomical relation between the carotid artery or laryngopharynx and the needle path via anterolateral oblique approach to C2 vertebral body,and whether the simulated path can direct the actual procedure.Methods Contrast agent was injected into bilateral carotid arteries of 10 fresh cadavers(20 sides),and then CT was performed.Bilateral simulated puncture paths were achieved on two-dimensional reconstruction of CT.The distance between the puncture site and middle line(AC),the angle between the simulated puncture paths and the median sagittal plane(?AOB),the distance between the simulated puncture paths and the wall of hypopharynx,or the carotid artery was measured respectvely.Under the guidance of fluoroscopy,oblique puncture via anterolateral to C2 was performed according to the simulated parameters,and then CT was done.The actual needle path is measured on the image of two-dimensional reconstruction of CT.The outcomes were compared using paired t test.Results Bilateral simulated puncture paths in all 10 cadavers were achieved on two-dimensional reconstruction of CT.The bilateral punctures via anterolateral to C2 were successfully performed under fluoroscopic guidance in 10 cadavers,and the actual needle path could be showed on two-dimensional reconstruction of CT.The average AC of the left simulated approach was 4.7cm,and the right was 5.2cm.The average AC of left real needle path was 4.5cm,the right was 5.1cm,and there was no significant difference within group and between groups(P>0.1).The average angle AOB of left approach was 33.3 degrees,the right was 35.8 degrees;the average angle AOB of the left actual needle pathwas 32.8 degrees,the right was 35.4 degrees,and there was no significant difference within group and between groups(P>0.5).The left and right average distance between the carotid artery and the simulated approach were 6.7mm and 7.5mm respectively;The distance between the side wall of hypopharynx and the simulated approach were 6.6mm and 7.2mm respectively.The left and right average distance between the carotid artery and the actual needle pathwere 6.7mm and 7.4mm respectively;The distance between the side wall of hypopharynx and the actual needle pathwere 7.1mm and 7.2mm respectively.There was not significantly different respectively between them(P>0.09).Conclusion The simulated approach via anterolateral to C2 could be achieved on two-dimensional reconstruction of CT,and was consistent with the real needle path and could be used to direct the actual practice to improve the accuracy and safety.