First clinical experience in applying XperGuide in embolization of jugular paragangliomas by direct intratumoral puncture

Purpose The purpose of this study is to introduce a novel image-guided technique utilized in the embolization of jugular paraganglioma tumors, using preoperative diagnostic scans and planning together with perioperative X-ray fluoroscopy in a combined image. Methods A lesion center and a skin entry point on the patient are selected and connected with a straight line, which resembles the most ideal lesion access trajectory to be followed during the needle insertion. The skin entry point and the corresponding line location are selected such that it avoids the impenetrable bones and vital anatomical structures. Two viewing incidence angles are defined to guide the cranial needle insertion: the entry view tangent to the planned trajectory, and the progression view perpendicular to the path. Results The proposed method was applied in two patients with jugular paragangliomas in order to navigate needles to the lesion location and subsequently embolize the tumors. The perioperative registration took less than 8 s. Using this method, it was possible to guide the needle within 5 mm of the planned path. Conclusion The fluoroscopic needle navigation, overlaid on the corresponding soft tissue of the underlying anatomy, combined with a planned path, has been shown to be an accurate and efficient tool for needle guidance. The patient pose varied between the preoperative data and the fluoroscopy guided intervention, but this did not hinder the procedure.