Puncturing vessels
-
-
Hello colleagues,
Very often , especially when doing S1 TFESI, my needle puncture vesseles while I think I am in the correct space and whatever advance or withdraw the needle could not get rid of blood.
What is your suggestion to decrease chance of vessele puncture and how can I correct my technique ? -
Retrodiscal approach for traversing S1 in anterior epidural space at L5-S1 level may avoid vessels.
-
Blunt needle may decrease risk but not completely with thin walled veins. Advance in lateral view into caudal canal Slowly
-
-
What do you mean by ‘lesion of Trigeminal root on MRI” is there still residual tumor?.. if so possible stereotactic radiosurgery that is also used for trigeminal pain.. RF does work but need to get facial numbness in this sort of case.The iliac vessels are nateriolateral to the L5-s1 disc. If you approach just lateral to the facet joint in an oblique manor there should be no way you hit the vessel. MRI clearly shows both T2 signal change and herniation of the L5-S1 disc so it is not clear why you would treat the L4-5 disc since evokative discography has been notoriously inaccurate as in this case.
-Robert e Jacobson, MD neurosurgeon
-
I see this often, I pull back to the posterior entrance to the S1 neural foramen, then slowly inject omni advancing as the vascular structures are gemera;;u dorsal, one can push past them to the ventral surface not entering the ventral S1 foramen on lateral. At this point a paresthesia is often encountered and the sleevegram lights up the S1 nicely, I never had a known complication doing this careful to avoid intravascular injection.
-
