bone puncture

A CT scan is performed to localize precisely the tumor. CT is used to measure the diameter of the nidus. The largest diameter of the nidus determines the energy that will be necessary to coagulate the tumor. For diameters larger than 10 mm we use usually two fibers to ensure tumor destruction. The entry point and the pathway are determined by CT, avoiding nervous vascular and visceral structures. The penetration of the needle into the nidus is always extremely painful, therefore ILP is performed under neuroleptanalgesia. General anesthesia is used in children. The procedure is performed under strict sterility. The skin subcutaneous layers, muscles and the periosteum are infiltrated by local anethesia ( 1% lidocaine ) with a 22-gauge needle. The position of the 22-gauge needle is checked by fluoroscopy and CT. The 18-gauge needle is guided safely under CT guidance. Fluoroscopy is used in conjunction with CT whenever drilling is necessary.

Fig 5: CT pathway

Fig 6: CT pathway for bone puncture

Fig 7: Local anesthesia