bone drilling

• The tip of an 18-gauge needle must be placed into the central part of the nidus. Sometimes bone drilling is required to reach the nidus depending on perilesional hyperostosis.
• Subperiostal nidi or cortical nidi without major ossification are directly punctured with an 18-gauge spinal needle (Becton Dickinson, Rutherford, NJ).
  In cases with mild ossification or small cortex surrounding the lesion, a 14-gauge bone biopsy needle is more adequate (Ostycut, Angiomed / Bard, Karlsruhe, Germany). In cases of dense ossification, or of dense cortical bone surrounding the lesion, drilling is necessary.
• In these cases we use a 2-mm diameter hand drill or a 14-gauge Bonopty Penetration set (Radi Medical Systems Uppsala, Sweden) to allow insertion of the 18-gauge needle.

Fig 8: CT drilling

Fig 10: CT drilling

Fig 9: Drilling