32-year-old male with pituitary cancer, status post chemo and radiation in 2006. Radiation to left sacrum 6/30 through 7/10/2008. December 2008 MRI showed abnormal left hemisacrum, possibly representing disease progression. Please perform CT guided sacral biopsy. Following a discussion of the procedures risks, benefits and alternatives, informed written consent was obtained from the patient's mother.The patient was placed in a prone position. A radiopaque grid was placed over the patient’s left sacrum for needle localization. Using multidetector helical CT, axial 5 mm scans were obtained through the sacrum demonstrating mild irregularity of the left superior sacroiliac joint. A trajectory was plotted into the left hemi-sacrum based on review of pelvis MRI 12/5/2008. The patient's lower back was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of the left hemisacrum. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the left hemisacrum. A bone biopsy was performed with an inner bone cutting needle, which yielded a solid bone core. The sample was placed in formalin and sent directly to pathology for diagnostic analysis. The coaxial needle was removed and adequate stasis was achieved with manual compression for 5 minutes.The patient tolerated the procedure well with no immediate complications. The patient remained neurologically intact at baseline at the end of the procedure. The patient was transferred to interventional radiology holding for routine post-procedure monitoring.
Successful CT-guided core bone biopsy of the left hemisacrum.