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Imaging anatomy of the vertebral canal for trans-sacral hiatus puncture of the lumbar cistern.
Trinh, Austin; Hashmi, Syed S; Massoud, Tarik F.
Affiliation
  • Trinh A; Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
  • Hashmi SS; Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
  • Massoud TF; Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
Clin Anat ; 34(3): 348-356, 2021 Apr.
Article in En | MEDLINE | ID: mdl-32323367
ABSTRACT
A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image-guided percutaneous trans-sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography-myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were FM = 2515, with a mean age of 44.9 years. The two S1-S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1-S2. The mean S2-S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two-way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1-S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans-sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sacrococcygeal Region / Sacrum / Spinal Canal / Subarachnoid Space / Anesthesia, Caudal Type of study: Observational_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: Clin Anat Journal subject: ANATOMIA Year: 2021 Document type: Article Affiliation country: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sacrococcygeal Region / Sacrum / Spinal Canal / Subarachnoid Space / Anesthesia, Caudal Type of study: Observational_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: Clin Anat Journal subject: ANATOMIA Year: 2021 Document type: Article Affiliation country: United States