E-129 Suboccipital puncture: a lost art?

Le résumé fourni par la source

Access to the subarachnoid space has both diagnostic and therapeutic implications. A multitude of routes have been described, including lumbar, lateral atlanto-occipital, and suboccipital puncture for access to the cisterna magna. Suboccipital puncture, a now seemingly archaic technique, was initially popular and widely implemented in the early 20th century due to the capacious foramen magnum and outstanding safety profile. Lumbar puncture eventually replaced the former due to the ease of access, decreased risk of catastrophic injury, and reliability of access without image guidance. However, there is now a growing body of literature which clearly demonstrates that therapeutic delivery via suboccipital puncture results in superior cortical and cervical spine exposure when compared to lumbar puncture. This is germane for a number of congenital and acquired diseases which could potentially be treated with adeno-associated virus (AAV) gene therapy as well as other treatment modalities. The suboccipital approach can also serve as a viable alternative for diagnostic CSF access in those cases in which the lumbar and C1-C2 approaches are contraindicated or not possible for anatomic reasons. Herein, we describe a modernized iteration of the suboccipital approach under image guidance which with appropriate training can readily be added to the armamentarium of spinal interventionalists for an alternative route of CSF access as well as therapeutic delivery. Disclosures N. Katz: None. D. Cohen-Addad: None. S. Alkhatib: None. B. Pukenas: None.

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