Techniques to Improve the Efficacy of Percutaneous Biopsy Procedures for Cavernous Sinus Lesions

The cavernous sinus can be affected by pathologies with profound clinical implications. Therefore, obtaining an accurate diagnosis with minimal disruption of native tissue is needed. Percutaneous needle aspiration biopsy through the foramen ovale using the Härtel corridor is one option. The diagnostic yield is around 86%, typically failing in cases where the tissue is firm.

This work describes a new method of percutaneous biopsy to increase the diagnostic yield in cases where the tissue is firm and not deliverable into the biopsy needle via a suction device.

Under general anesthetic, a percutaneous approach through the foramen ovale was performed. A k-wire was then placed and the needle was removed. A 14-ga angiocatheter was then placed using the over-the-wire technique. Once the K-wire was removed, endoscopic graspers were used to biopsy the lesion through the angiocatheter, providing reasonably sized biopsy specimens.

This technique was applied when fine needle aspiration failed and resulted in successful pathologic diagnosis.

This technique for minimally invasive biopsy of the cavernous sinus is potentially safe and can be performed when fine needle aspiration is unsuccessful or larger samples are required for definitive diagnosis.