C1‐2 Puncture: A Safe, Efficacious, and Potentially Underused Technique

A C1‐2 puncture for injection of myelographic contrast, CSF collection, or administration of intrathecal chemotherapy is much less frequently used now than in the past. This is partially due to increased use of MR imaging for spinal imaging and decreased use of myelography. However, there are contraindications to a lumbar approach, and, occasionally, a lumbar puncture fails, which requires a cervical approach to the subarachnoid space. Many neuroradiologists and trainees receive little practice in the technique and have the perception that the procedure is dangerous and difficult to perform. A careful review of the literature revealed that complications are few. This review described the history of the C1‐2 approach, indications, technique, and relevant anatomy, and a review of the literature related to a procedure's complications. We concluded with a discussion of situations in which a C1‐2 puncture is preferred by providing increased comfort and safety for select patient populations.

Learning Objective: Understand the key components of a safe C1‐2 puncture, including proper technique, anatomy, and potential complications.