22 Gauge Needle

Hubless Needles
Fig. 5. Coaxial trephine system. (Geremia, Cook, Bloomington, IN.) (A) Coaxial introduction cannula. (B) 22-Gauge guiding needle with removable hub. (C) Trephine needle.
Coaxial Bone Biopsy System

Fig. 6. Diagram of coaxial trephine needle system. After local anesthesia, the 22-gauge needle is advanced to the desired site on the bony surface (A). The stylet is removed and the periosteum is anesthetized through the needle with local anesthesia. Subsequently, the hub is removed and a coaxial introduction cannula is advanced over the needle to the site (B,C). (The Geremia system replaces the stylet with a hubless stiffing stylet prior to the coaxial canula placement). After removal of the 22-gauge guiding needle and inner cannula, the trephine needle is advanced through the outer cannula to the lesion (D,E). The coaxial placement allows the trephine needle to follow the predetermined safe pathway made by the 22-gauge guiding needle. In addition, coaxial biopsy through the outer cannula can be performed with FNA or automated cutting needles (F).

Fig. 6. Diagram of coaxial trephine needle system. After local anesthesia, the 22-gauge needle is advanced to the desired site on the bony surface (A). The stylet is removed and the periosteum is anesthetized through the needle with local anesthesia. Subsequently, the hub is removed and a coaxial introduction cannula is advanced over the needle to the site (B,C). (The Geremia system replaces the stylet with a hubless stiffing stylet prior to the coaxial canula placement). After removal of the 22-gauge guiding needle and inner cannula, the trephine needle is advanced through the outer cannula to the lesion (D,E). The coaxial placement allows the trephine needle to follow the predetermined safe pathway made by the 22-gauge guiding needle. In addition, coaxial biopsy through the outer cannula can be performed with FNA or automated cutting needles (F).

mined safe pathway made by the 22-gauge guiding needle. In addition, coaxial biopsy through the outer cannula can be performed with FNA or automated cutting needles (Fig. 6F).

Combination Needles Combination needles combine features of cutting and trephine needles (42). They are a two-part needle with an outer hollow cutting needle and an inner trocar-boring needle (Fig. 7). (Jamshidi, Manan Medical Products, Northbrook, IL; Ostycut, CR Bard, Covington, GA; Osteosite Cook, Bloomington, IN). They vary in the size and the tip configuration of the outer and inner needles. Interlocking handles are attached to both the inner and outer needles and allow advancement of the needle using a clockwise rotary motion similar to a drill. For bone marrow aspiration, the needle is advanced as a unit through the cortical bone into the medullary space. The inner trocar is removed and negative pressure is applied to the outer needle using a syringe to obtain an aspirate. For a cancellous bone biopsy, the needle is advanced as a unit to engage the bone surface at the desired site. The trocar is removed and the outer needle is advanced using either a manual clockwise (drilling) motion or tapping on the needle handle with an orthopedic hammer. The outer needle is removed and the inner trocar needle is used to remove the specimen. The outer needle can be reintroduced through the previous tract and act as a guiding cannula for coaxial biopsies using cutting and FNA needles (12).

The Osteo-Rx needle (Cook, Bloomington, IN) represents an adaptation of the combination needle to provide a broader access to the vertebral body (Figs. 8 and 9). A 10-gauge combination needle is advanced through the outer cortical bone into the vertebral body. The inner trocar needle is removed and a steerable 13-gauge nitinol beveled needle with a 90° curved tip is advanced coaxially through the outer needle into the vertebral body. After the inner stylet is removed, an aspiration syringe is attached and the needle can be advanced to multiple locations within the vertebral body. This needle allows biopsy of multiple sites within the vertebral body from a single access (Fig. 9). The needle was originally devel-oped for use in vertebroplasty but has been limited by its rela-tively large size.

MRI-Compatible Needles With advances in MRI and its superior soft tissue contract resolution, interventional MRI potentially has a promising future (16,17,61-69). Although commercially available stainless steel needles do not generate significant torque during MRI, they create large imaging artifacts. Needle alloys of stainless steel and nickel reduce a needle's magnetic susceptibility and imaging artifacts. Recent articles have described successful biopsies with MRI-compatible needles using FNA (18- to 22-gauge, E2-EM, Westbury, NY) and core (Comatex, Berlin, Germany—Biogun, E-2-EM, Westbury, NY—Daum, Schwerin, Germany) biopsy systems (16,17).

Geremia Biopsy
Fig. 7. (A, B) Combination needles. (A) Osteo-site bone biopsy needle. (Cook, Bloomington, IN.) (B) Bone marrow biopsy needle. (MDTech, Gainesville, FL.)
Vertebral Needle
Fig. 8. Combination needles. (Osteo-Rx needle, Cook, Bloomington, IN.) (A) 10-Gauge combination needle. (B) Steerable 13-gauge nitinol beveled needle.
Lateral Osteo
Fig. 9. (A, B) Anteroposterior and lateral views of the Osteo-Rx needle.

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