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Guzzi G, Ricciuti RA, Della Torre A, Lo Turco E, Lavano A, Longhini F, La Torre D. Intraoperative Neurophysiological Monitoring in Neurosurgery. J Clin Med 2024; 13:2966. [PMID: 38792507 PMCID: PMC11122101 DOI: 10.3390/jcm13102966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.
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Affiliation(s)
- Giusy Guzzi
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | | | - Attilio Della Torre
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Erica Lo Turco
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Angelo Lavano
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
- Anesthesia and Intensive Care Unit, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
| | - Domenico La Torre
- Neurosurgery Department, “R. Dulbecco” Hospital, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
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Parvinian A, Morris JM, Johnson-Tesch BA, Kurup AN. Thermoprotection of Neural Structures During Musculoskeletal Ablation. Cardiovasc Intervent Radiol 2023; 46:1495-1503. [PMID: 36944852 DOI: 10.1007/s00270-023-03407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
Percutaneous thermal ablation is widely used for local control and palliation of a variety of lesions throughout the musculoskeletal system. In this setting, safe ablation is predicated on the avoidance of unintentional injury to vulnerable neural structures that are often in proximity to ablation targets. This article highlights key periprocedural considerations in musculoskeletal ablation and reviews the array of active and passive thermoprotective measures that are critical to safe and successful treatment.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Papalexis N, Savarese LG, Peta G, Errani C, Tuzzato G, Spinnato P, Ponti F, Miceli M, Facchini G. The New Ice Age of Musculoskeletal Intervention: Role of Percutaneous Cryoablation in Bone and Soft Tissue Tumors. Curr Oncol 2023; 30:6744-6770. [PMID: 37504355 PMCID: PMC10377811 DOI: 10.3390/curroncol30070495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
In the rapidly evolving field of interventional oncology, minimally invasive methods, including CT-guided cryoablation, play an increasingly important role in tumor treatment, notably in bone and soft tissue cancers. Cryoablation works using compressed gas-filled probes to freeze tumor cells to temperatures below -20 °C, exploiting the Joule-Thompson effect. This cooling causes cell destruction by forming intracellular ice crystals and disrupting blood flow through endothelial cell damage, leading to local ischemia and devascularization. Coupling this with CT technology enables precise tumor targeting, preserving healthy surrounding tissues and decreasing postoperative complications. This review reports the most important literature on CT-guided cryoablation's application in musculoskeletal oncology, including sarcoma, bone metastases, and bone and soft tissue benign primary tumors, reporting on the success rate, recurrence rate, complications, and technical aspects to maximize success for cryoablation in the musculoskeletal system.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Leonor Garbin Savarese
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-09, Brazil
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Hawkins CM, Gill AE. Introduction to interventional radiology's role in palliative care for children with cancer: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30238. [PMID: 36715273 PMCID: PMC10658401 DOI: 10.1002/pbc.30238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
As palliative care continues to be an area of increasing emphasis in pediatric oncology programs, it is important to raise awareness about minimally invasive, image-guided procedures that can supplement more conventional palliative interventions, such as systemic analgesics, external beam radiation, and locoregional anesthesia. These procedures, when performed for appropriately selected patients, can often facilitate discharge from an inpatient facility, and help patients meet their end-of-life goals. This article specifically discusses three palliative procedures performed by interventional radiologists that can assist pediatric palliative care teams in: (a) percutaneous thermal ablation of painful bone metastases, (b) cryoneurolysis, and (c) tunneled drainage catheter placement for malignant pleural effusions and ascites.
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Affiliation(s)
- C. Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children’s Pediatric Institute, Children’s Healthcare of Atlanta, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Anne E. Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children’s Pediatric Institute, Children’s Healthcare of Atlanta, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
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Yang T, Ke J, Cheng S, He Y, Huang W, Yao M, Zhou J, Zhong G, Hu Y, Zhang Y. Clinical guidelines for microwave ablation of spinal metastases. J Cancer Res Ther 2022; 18:1845-1854. [PMID: 36647941 DOI: 10.4103/jcrt.jcrt_655_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of spinal metastases. However, there is still controversy in terms of clinical treatment, such as indication, power, time, and temperature. To standardize the application of microwave ablation technology and reduce the risk of surgical-related complications in spinal metastases, in this report, we aimed to summarize the current evidence and clinical experience of microwave ablation and developed a clinical guideline, initiated by the Musculoskeletal Tumor Group of the Committee for Minimally Invasive Therapy in Oncology of the Chinese Anti-Cancer Association. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in to rate the quality of evidence and the strength of recommendations, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist was strictly followed to report the guideline. Finally, 15 evidence-based recommendations were formulated based on the 15 most concerned clinical questions among orthopedic surgeons, oncologists, and interventional radiologists in China. This guideline aims to promote the science-based normalization of microwave ablation for the treatment of spinal metastases.
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Affiliation(s)
- Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jin Ke
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yue He
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Mengyu Yao
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jielong Zhou
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yongcheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
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Tumor-Specific Immunoenhancing Effects after Local Cryoablation for Metastatic Bone Tumor in a Mouse Model. Int J Mol Sci 2022; 23:ijms23169445. [PMID: 36012709 PMCID: PMC9409399 DOI: 10.3390/ijms23169445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated the abscopal effect after cryoablation (CA) on bone metastasis using a mouse model. Breast cancer cells were implanted in the bilateral tibiae of mice. The left tumor was treated locally with CA, and the right abscopal tumor (AT) was left untreated. The mice were divided into four groups based on the combination of CA and intraperitoneal administration of anti-PD-1 antibody (PD) as treatment interventions (Control, CA, PD, and CA + PD). The reduction ratio of the size of AT, the quantitative immune effects at enzyme-linked immunospot (ELISPOT) assay, and the intensity of infiltration of immune-related cells to AT were compared among the groups. CA alone showed a significant immunoenhancing effect on the volume change ratio of AT from day 0 to day 14 (Control-CA: p < 0.05), ELISPOT assay (Control-CA: p < 0.01), and CD4+ cell count in immunostaining (Control-CA: p < 0.05). CA alone showed no significant immunoenhancing effect on CD8+ and Foxp3+ cell counts in immunostaining, but the combination of CA and PD showed a significant immunoenhancing effect (Control-CA + PD: p < 0.01 [CD8, Foxp3]). The results suggested that the abscopal effect associated with the local cryotherapy of metastatic bone tumors was activated by CA and enhanced by its combination with PD.
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Arleo TL, Hawkins CM, Fabregas JA, Gill AE. Percutaneous image-guided treatment of aneurysmal bone cysts: is there a superior treatment option? Pediatr Radiol 2022; 52:1539-1549. [PMID: 35325265 DOI: 10.1007/s00247-022-05326-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are often treated with intralesional surgery (curettage) with or without adjuvant treatments. Side effects and conflicting results regarding recurrence rates do not suggest one clearly superior therapy. Percutaneous therapeutic options including sclerotherapy and thermal ablation have gained popularity as potential alternatives. OBJECTIVE The purpose of this retrospective review is to report this institution's experience and results of various image-guided minimally invasive treatments in a single institution series of cases referred to interventional radiology by orthopedic surgery after surgical failure or in patients with anatomically challenging ABCs. MATERIALS AND METHODS This study identified all patients ≤18 years old who received percutaneous therapy for an ABC, including cryoablation, doxycycline sclerotherapy, microwave ablation or a combination of these modalities. Procedural details, complications, imaging follow-up and clinical follow-up were analyzed. RESULTS A total of 21 patients received 41 procedures, with major complications seen in 7.7% (3/39) of procedures involving cryoablation or doxycycline sclerotherapy. Patients receiving cryoablation required an average of 1.7 procedures (median: 1 procedure, range: 1-4 procedures) while patients receiving doxycycline sclerotherapy required an average of 3 procedures (median: 2 procedures, range: 1-6 procedures). Patients were followed clinically and with computed tomography or magnetic resonance imaging (average: 23.9 months, range: 3.9-68.3 months). Follow-up imaging demonstrated improvement in 17 (85%) patients. Clinically, 93.8% (15/16) of patients who presented with fracture or pain had markedly reduced or absent pain as well as no fractures. CONCLUSION Percutaneous image-guided treatment of ABCs demonstrates a favorable efficacy and safety profile. Adding cryoablation may lead to fewer total procedures than using doxycycline sclerotherapy alone.
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Affiliation(s)
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA. .,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Jorge A Fabregas
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Scottish Rite Campus, Atlanta, GA, USA
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
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8
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Thompson SM, Welch BT, Kurup AN. Ablation for oligometastatic colorectal carcinoma in extrahepatic, extrapulmonary sites. Int J Hyperthermia 2022; 39:633-638. [DOI: 10.1080/02656736.2021.1952318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Brian T. Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - A. Nick Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Tomasian A, Jennings JW. Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases. Semin Intervent Radiol 2022; 39:176-183. [PMID: 35781996 DOI: 10.1055/s-0042-1745787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The musculoskeletal system is commonly involved by metastases, and skeletal-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a result of nerve compression often adversely affect patient's quality of life. There have been substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions for the management of patients with musculoskeletal metastases including thermal ablations, cementation with or without osseous reinforcement via implants, osteosynthesis, neurolysis, and palliative injections which are progressively incorporated in clinical practice. These interventions are performed, in conjunction with or supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesics, to achieve durable pain palliation, local tumor control, or cure. This article reviews minimally invasive percutaneous image-guided musculoskeletal oncologic interventions for the management of patients with extraspinal musculoskeletal metastases.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of California Irvine, Orange, California
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, Missouri
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Strommen JA, Skinner S, Crum BA. Neurophysiology during peripheral nerve surgery. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:295-318. [PMID: 35772892 DOI: 10.1016/b978-0-12-819826-1.00022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Electrophysiological monitoring of the peripheral nervous system during a variety of surgeries provides useful information that supplements and complements preoperative assessment. Monitoring improves localization and understanding of the underlying pathophysiology of peripheral nerve lesions leading to more rational treatment decisions and improved outcomes. Monitoring is accomplished by adaptation of routine electrodiagnostic techniques (i.e., nerve conduction studies, evoked potentials, and electromyography) with special attention to technical factors including electrical and movement artifact. These techniques have been successfully applied during surgery for entrapment neuropathies, traumatic nerve injury and repair, peripheral nerve tumors, and adjacent structure procedures that risk peripheral nerve injury. A clear understanding of the anatomy and neurophysiology is necessary, as is understanding and performing the difficult technical aspects of these studies to provide accurate information to enhance patient outcome and recovery. As in any intraoperative neurophysiologic monitoring (IONM) setting, constant and accurate communication between the IONM team, surgeon, and anesthesia team is critically important to meet these goals.
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Affiliation(s)
- Jeffrey A Strommen
- Department of Neurophysiology, Abbott Northwestern Hospital, Minneapolis, MN, United States.
| | - Stanley Skinner
- Department of Intraoperative Neurophysiology, Abbott Northwestern Hospital, Minneapolis, MN, United States.
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Stanborough RO, Long JR, Garner HW. Bone and Soft Tissue Tumors. Radiol Clin North Am 2022; 60:311-326. [DOI: 10.1016/j.rcl.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Yevich S, Chen S, Metwalli Z, Kuban J, Lee S, Habibollahi P, McCarthy CJ, Irwin D, Huang S, Sheth RA. Radiofrequency Ablation of Spine Metastases: A Clinical and Technical Approach. Semin Musculoskelet Radiol 2021; 25:795-804. [PMID: 34937119 DOI: 10.1055/s-0041-1740351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Percutaneous radiofrequency ablation (RFA) is an integral component of the multidisciplinary treatment algorithm for both local tumor control and palliation of painful spine metastases. This minimally invasive therapy complements additional treatment strategies, such as pain medications, systemic chemotherapy, surgical resection, and radiotherapy. The location and size of the metastatic lesion dictate preprocedure planning and the technical approach. For example, ablation of lesions along the spinal canal, within the posterior vertebral elements, or with paraspinal soft tissue extension are associated with a higher risk of injury to adjacent spinal nerves. Additional interventions may be indicated in conjunction with RFA. For example, ablation of vertebral body lesions can precipitate new, or exacerbate existing, pathologic vertebral compression fractures that can be prevented with vertebral augmentation. This article reviews the indications, clinical work-up, and technical approach for RFA of spine metastases.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Chen
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeyad Metwalli
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Lee
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peiman Habibollahi
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colin J McCarthy
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Irwin
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Huang
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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Tomasian A, Jennings JW. Bone Metastases: State of the Art in Minimally Invasive Interventional Oncology. Radiographics 2021; 41:1475-1492. [PMID: 34469219 DOI: 10.1148/rg.2021210007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. ©RSNA, 2021.
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Affiliation(s)
- Anderanik Tomasian
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Jack W Jennings
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
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Augustine MR, Thompson SM, Powell GM, Koepsel EK, Adamo DA, Bendel EC, Anderson KR, Bjarnason H, Tollefson M, Woodrum DA. Percutaneous MR Imaging-Guided Laser Ablation and Cryoablation for the Treatment of Pediatric and Adult Symptomatic Peripheral Soft Tissue Vascular Anomalies. J Vasc Interv Radiol 2021; 32:1417-1424. [PMID: 34332090 DOI: 10.1016/j.jvir.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of percutaneous magnetic resonance (MR) imaging-guided laser ablation and cryoablation for the treatment of symptomatic soft tissue vascular anomalies (VAs) of the trunk and extremities. MATERIALS AND METHODS An institutional review board-approved retrospective review was undertaken of all pediatric and adult patients who underwent MR imaging-guided and monitored laser ablation and/or cryoablation for the treatment of symptomatic peripheral soft tissue VA. Preablation and postablation MR imaging was independently reviewed. Pain scores on the visual analog scale (0 to 10) and self-reported subjective symptomatic improvement were assessed. Change in VA size and pain scores were compared using a paired t test. RESULTS Thirty patients (24 females; age, 10-75 years) with 34 VAs were treated for moderate to severe pain (n = 27) or swelling/mass effect (n = 3) with 60 total ablation sessions. The baseline maximum VA diameter was 9.5 cm ± 8.6. At baseline, all VAs (100%) demonstrated variable T2-weighted signal hyperintensity and enhancement. The baseline pain score was 6.4 ± 1.6. Clinical follow-up was available for 23 patients. At a mean follow-up time of 12.2 months ± 10.1, 19 of 20 (95%) patients treated for pain and 2 of 3 (67%) patients treated for swelling/mass effect reported partial or complete symptomatic relief. There was a significant decrease in the postablation pain scores (-5.7 ± 1.0, P < .001) and maximum VA size (-2.3 cm ± 2.7, P = .004), with >50% reduction in VA T2 signal (59%) and enhancement (73%). Nine of 30 (30%) patients experienced minor complications. CONCLUSIONS MR imaging-guided and monitored percutaneous laser ablation and cryoablation appear to be safe and effective for the treatment of symptomatic peripheral soft tissue VAs.
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Affiliation(s)
| | | | | | | | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Emily C Bendel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Autrusseau PA, Cazzato RL, De Marini P, Auloge P, Koch G, Dalili D, Weiss J, Mayer T, Garnon J, Gangi A. Pain relief and local tumour control following percutaneous image-guided cryoablation for spine metastasis: a 12-year single-centre experience. Clin Radiol 2021; 76:674-680. [PMID: 34120732 DOI: 10.1016/j.crad.2021.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
AIM To assess pain relief and local tumour control retrospectively in spinal metastases undergoing cryoablation. MATERIALS AND METHODS Between May 2008 and September 2020, 46 metastases in 41 consecutive patients (mean age 59.7±4.4 [SD] years; range 27-84) were treated with cryoablation in 42 interventional sessions. Patient demographics, procedural data, complications, pain, and local tumour control were analysed retrospectively. RESULTS Thirty-one patients (36 spine metastases; 32 sessions) were treated for pain relief and 10 (10 metastases; 10 sessions) for local tumour control. Clinical success was reached in 30/32 (93.8%) interventional palliative sessions. Mean pre-procedural numerical pain rate scale was 6.2±1.7 (SD), and dropped significantly to 3.5±1.8 (SD), 1.9±1.7 (SD), and 1.9±1.8 (SD) at 24-h, 1-month and at the last available follow-up (median 16.5±23.2 [SD] months), respectively. For patients requiring local tumour control, primary clinical success was reached in 6/10 (60%) spinal metastases at median 25-months follow-up. The overall complication rate was 8%, with no secondary fractures or iatrogenic thermal-mediated nerve injuries reported. CONCLUSION Percutaneous image-guided cryoablation of spinal metastases is safe and effective in achieving pain relief and local tumour control.
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Affiliation(s)
- P-A Autrusseau
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - P De Marini
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - P Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - G Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - D Dalili
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - J Weiss
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - T Mayer
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - J Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - A Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
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Moynagh MR, Dowdy SC, Welch B, Glaser GE, Schmitz JJ, Jatoi A, Langstraat CL, Block MS, Kurup AN, Kumar A. Image-guided tumor ablation in gynecologic oncology: Review of interventional oncology techniques and case examples highlighting a collaborative, multidisciplinary program. Gynecol Oncol 2020; 160:835-843. [PMID: 33388156 DOI: 10.1016/j.ygyno.2020.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/23/2020] [Indexed: 01/20/2023]
Abstract
As interventional oncology services within radiology mature, image-guided ablation techniques are increasingly applied to recurrent gynecologic malignancies. Ablation may be performed using thermal techniques like cryoablation, microwave ablation, or radiofrequency ablation, as well as non-thermal ones, such as focused ultrasound or irreversible electroporation. Feasibility and approach depend on tumor type, size, number, anatomic location, proximity of critical structures, and goals of therapy. Current indications include local control of limited metastatic disease or palliation of painful bone metastases refractory or unsuitable to conventional therapies. Technical aspects of these procedures, including methods to protect nearby critical structures are presented through illustrative examples. Cases amenable to image-guided ablation include, but are not limited to, hepatic or pulmonary metastases, musculoskeletal metastases, retroperitoneal nodal metastases, pelvic side wall disease, abdominal wall disease, and vaginal or vulvar tumors. Protective maneuvers, such as hydro-displacement of bowel, neuromonitoring, and retrograde pyeloperfusion through ureteral stents, permit safe ablation despite close proximity to vulnerable nerves or organs. Image-guided ablation offers an alternative modality to achieve local tumor control without the risks associated with surgery or systemic treatment in appropriately selected patients. A multidisciplinary approach to use of image-guided ablation includes collaboration between gynecologic oncology, interventional radiology, anesthesia, urology and radiation oncology teams allowing for appropriate patient-centered case selection. Long-term follow up and additional studies are needed to determine the oncologic benefits of such techniques.
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Affiliation(s)
- Michael R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Brian Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
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18
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Cazzato RL, Garnon J, Koch G, Dalili D, Rao PP, Weiss J, Bauones S, Auloge P, de Marini P, Gangi A. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465. [DOI: 10.1259/bjr.20200465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Windmill Rd, Oxford OX3 7LD, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julia Weiss
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Salem Bauones
- Department of Radiology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
- Department of Interventional Radiolgy, Guy's and St Thomas' NHS Foundation Trust, King's College London, London WC2R 2LS, United Kingdom
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Key BM, Scheidt MJ, Tutton SM. Advanced Interventional Pain Management Approach to Neoplastic Disease Outside the Spine. Tech Vasc Interv Radiol 2020; 23:100705. [PMID: 33308576 DOI: 10.1016/j.tvir.2020.100705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neoplastic disease of the musculoskeletal system may result in serious morbidity and mortality secondary to cancer related bone pain, pathologic fracture, altered structural mechanics, and involvement of adjacent structures.1 Recent advances in cancer detection and treatment have allowed more patients to live longer. The prevalence of osseous metastatic disease has increased to 100,000 new patients developing bone metastases each year.2 These patients are seeing long-term exposure to chemotherapy and radiation leading to increased skeletal events, morbidity, and a negative impact on quality of life. Bone metastases in conjunction with poor bone quality often prevent surgical therapy. Utilization of thermal ablation in this patient population is supported by contemporary literature and offers a minimally invasive approach to pain palliation, local tumor control, and decreased morbidity with unique advantages compared to surgery or radiation.3 In addition to spine disease, interventional radiologists are able to meaningfully impact pelvic, shoulder girdle, and long bone metastases. Adding to ablation we have in our repertoire the ability to provide structural support utilizing cement and/or screw fixation as an adjunct for both pain palliation and mechanical stabilization.4-6 These novel therapies have allowed more patients with metastatic disease to be treated. The focus of this chapter is to highlight importance of patient selection, ablative modality selection, integration of cementoplasty (also described as osteoplasty) and osseous fixation, and procedural techniques/strategy in the pelvis and other common sites of bone metastases outside the spine.
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Percutaneous Minimally Invasive Thermal Ablation of Osseous Metastases: Evidence-Based Practice Guidelines. AJR Am J Roentgenol 2020; 215:502-510. [DOI: 10.2214/ajr.19.22521] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Spinal metastases treated with bipolar radiofrequency ablation with increased (>70°C) target temperature: Pain management and local tumor control. Diagn Interv Imaging 2020; 102:27-34. [PMID: 32482583 DOI: 10.1016/j.diii.2020.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate the safety and clinical efficacy of bipolar radiofrequency ablation (b-RFA) with increased (>70°C) target temperature for the treatment of spine metastases with the intent of achieving pain relief or local tumor control. MATERIALS AND METHODS Thirty-one patients with a total of 37 metastases who were treated with b-RFA with increased temperature and vertebroplasty from January 2016 to May 2019 were retrospectively included. There were 20 women and 11 men with a mean age of 62.4±10.5 (SD) years (range: 40-78years). Patients and metastases characteristics, procedure details and clinical outcomes were analyzed. RESULTS Metastases were predominantly located in lumbar (22/37; 59.5%) or thoracic spine (13/37; 35.1%). Mean target temperature was 88.4±3.5 (SD) °C (range: 70-90°C). Technical success was 100% (37/37 metastases). One (1/37; 2.7%) major complication unrelated to b-RFA was reported. One (1/37; 2.7%) metastasis was lost to follow-up. Favorable outcome was noted in patients receiving b-RFA for pain management (16/20 metastases; 80%; mean follow-up, 3.4±2.9 [SD] months) or with oligometastatic/oligoprogressive disease (6/6 metastases; 100%; mean follow-up, 5.0±4.6 [SD] months). In patients receiving b-RFA to prevent complications, favorable outcome was noted in 6/10 metastases (60%; mean follow-up, 3.8±4.8 [SD] months). CONCLUSIONS B-RFA with increased target temperature has an excellent safety profile and results in high rates of pain relief and local metastasis control in patients with oligometastatic/oligoprogressive disease. Suboptimal results are achieved in patients receiving b-RFA to prevent complications related to the growth of the index tumor.
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Parvinian A, Welch BT, Callstrom MR, Kurup AN. Trends in Musculoskeletal Ablation: Emerging Indications and Techniques. Tech Vasc Interv Radiol 2020; 23:100678. [PMID: 32591190 DOI: 10.1016/j.tvir.2020.100678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Image-guided percutaneous thermal ablation plays an increasingly important role in the multidisciplinary management of musculoskeletal lesions. Established indications for ablation in this setting include the treatment of osteoid osteomas, palliation of painful skeletal metastases, local control of oligometastatic disease, and consolidation of bone tumors at risk for fracture. Emerging indications include the treatment of symptomatic soft tissue masses such as extra-abdominal desmoid tumors and abdominal wall endometriosis. This review will discuss considerations in patient selection and preprocedural workup, ablation technology and techniques, strategies to avoid complications, and expected outcomes of ablation in the musculoskeletal system.
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Affiliation(s)
| | | | | | - Anil N Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN
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23
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Natural History of Mixed and Motor Nerve Cryoablation in Humans-A Cohort Analysis. J Vasc Interv Radiol 2020; 31:912-916.e1. [PMID: 32376178 DOI: 10.1016/j.jvir.2019.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022] Open
Abstract
Eight patients who underwent percutaneous cryoablation of mixed and/or motor nerves over a period of 5 years were identified. Distances from the ablation sites to origins of distal musculature were measured, and times to initial clinical recovery were collected. Strength progression over time following muscle activation was also collected and analyzed. All patients demonstrated activation of all muscles distal to the ablation, and the calculated mean rate of nerve regeneration based on distance to the origin of the assessed musculature and time to muscle activation for the group was 1.5 mm/day ± 1.1.
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Utility of Motor and Somatosensory Evoked Potentials for Neural Thermoprotection in Ablations of Musculoskeletal Tumors. J Vasc Interv Radiol 2020; 31:903-911. [PMID: 32340861 DOI: 10.1016/j.jvir.2019.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/09/2019] [Accepted: 12/22/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To characterize the utility of monitoring transcranial electrical motor evoked potentials (TCeMEPs) and somatosensory evoked potentials (SSEPs) for neural thermoprotection during musculoskeletal tumor ablations. MATERIALS AND METHODS Retrospective review of 29 patients (16 male; median age, 46 y; range, 7-77 y) who underwent musculoskeletal tumor radiofrequency ablation (n = 8) or cryoablation (n = 22) with intraprocedural TCeMEP and SSEP monitoring was performed. The most common tumor histologies were osteoid osteoma (n = 6), venous malformation (n = 5), sarcoma (n = 5), renal cell carcinoma (n = 4), and non-small-cell lung cancer (n = 3). The most common tumor sites were spine (n = 22) and lower extremities (n = 4). Abnormal TCeMEP change was defined by 100-V increase above baseline threshold activation for a given myotome; abnormal SSEP change was defined by 60% reduction in baseline amplitude and/or 10% increase in latency. RESULTS Abnormal changes in TCeMEP (n = 9; 30%) and/or SSEP (n = 5; 17%) occurred in 12 procedures (40%) and did not recover in 5 patients. Patients with unchanged TCeMEP/SSEP activities throughout the procedure (n = 18) did not have motor or sensory symptoms after the procedure; 3 (60%) with unrecovered activity changes and 2 (29%) with transient activity changes had new motor (n = 1) or sensory (n = 4) symptoms. Relative risk for neurologic sequelae for patients with unrecovered TCeMEP/SSEP changes vs those with transient or no changes was 7.50 (95% confidence interval, 1.66-33.9; P = .009). CONCLUSIONS Abnormal activity changes of TCeMEP or SSEP during percutaneous ablative procedures correlate with postprocedural neurologic sequelae.
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Carabin J, Bouhamama A, Vaz G, Cuinet M, Ricoeur A, Thibaut A, Beji H, Mastier C, Pilleul F. Percutaneous Cryoablation of Symptomatic Intramuscular Venous Malformation. J Vasc Interv Radiol 2020; 31:558-563.e3. [PMID: 32113799 DOI: 10.1016/j.jvir.2019.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of cryoablation for venous malformations. MATERIALS AND METHODS A total of 12 patients with symptomatic intramuscular venous malformations who underwent percutaneous cryoablation between February 2015 and December 2018 were retrospectively studied. The mean age was 42 y (range, 19-58 y). Pain was reported by 11 patients (92%) and swelling by 1 (8%). Pain was assessed with a visual analog scale (VAS) before and after cryoablation. Lesion size was followed with magnetic resonance (MR) imaging at baseline and at 3-mo follow-up. Median initial VAS score was 7 (range, 0-8), and median initial lesion size was 32.5 mm (range, 11-150 mm). RESULTS The median VAS score at 3 mo was 0 (range, 0-4), and the median lesion size at 3 mo was 0 mm (range, 0-142 mm). Eleven of 12 patients reported an improvement in their pain. MR imaging control showed a treatment scar with no residual lesion in 5 patients and decreased lesion size in 4. No major complications were reported. One minor hematoma and 1 small myositis were noted as defined by Society of Interventional Radiology criteria. CONCLUSIONS Percutaneous cryoablation is effective and safe for treatment of symptomatic intramuscular venous malformations, with improvement of symptoms.
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Affiliation(s)
- Jonathan Carabin
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France.
| | - Amine Bouhamama
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Gualter Vaz
- Department of Orthopedic Surgery, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Marie Cuinet
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Antoine Thibaut
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Hedi Beji
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Frank Pilleul
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
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27
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Tomasian A, Jennings JW. Percutaneous minimally invasive thermal ablation for management of osseous metastases: recent advances. Int J Hyperthermia 2019; 36:3-12. [DOI: 10.1080/02656736.2019.1613573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Jack W. Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, MO, USA
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28
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Ridouani F, Srimathveeravalli G. Percutaneous image-guided ablation: From techniques to treatments. Presse Med 2019; 48:e219-e231. [PMID: 31447333 DOI: 10.1016/j.lpm.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.
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Affiliation(s)
- Fourat Ridouani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, USA
| | - Govindarajan Srimathveeravalli
- University of Massachusetts, Institute for Applied Life Sciences, Department of Mechanical and Industrial Engineering, Amherst, USA.
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29
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Lea WB, Neilson JC, King DM, Tutton SM. Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Technique. Semin Intervent Radiol 2019; 36:229-240. [PMID: 31435131 DOI: 10.1055/s-0039-1693982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Metastatic disease involving the pelvis is common, often resulting in significant pain and disability. Several percutaneous interventions for unstable pelvic metastatic disease have been described, including osteoplasty, ablation, and screw fixation, that when used alone or in combination can significantly reduce pain and disability from metastatic bone disease. While it is possible to make a significant impact in patient care with basic principles and techniques, certain advanced techniques can extend the application of percutaneous interventions while minimizing morbidity.
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Affiliation(s)
- William B Lea
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John C Neilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean M Tutton
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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30
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Abstract
OBJECTIVE. The aim of this observational study was to assess safety and clinical outcomes of percutaneous image-guided cryoablation (CA) to treat osteoblastomas (OBs) at various osseous sites. MATERIALS AND METHODS. A retrospective search was performed to identify patients presenting with painful OBs who underwent CA at the University Hospitals of Strasbourg between March 2007 and December 2018. Ten patients (seven men, three women; median age, 21 years old) were identified and included. Medical records were reviewed to assess complications and clinical outcomes. RESULTS. Median OB diameter was 16.5 mm (range, 16-28 mm). OBs were located in the spine (n = 7), calcaneus (n = 1), fibula (n = 1), and third metacarpal bone (n = 1). In 90% of cases (n = 9), one or more critical structures were within 1 cm of the OB (median distance, 5 mm; range, 2-8 mm), thus requiring extensive protective measures. Technical success was achieved in all cases. Two (20%) immediate neural complications were noted. One major complication was consistent with a permanent sensory deficit of the arm. One minor complication was consistent with a transient right Horner syndrome, which completely resolved after 48 hours with high-dose steroids. Median clinical follow-up was 12 months. Primary clinical success was 100% and 78% at 1 and 12 months of follow-up, respectively, with two patients presenting with recurring pain. CONCLUSION. Percutaneous image-guided CA represents an effective therapeutic option for patients affected by painful OBs; the safety profile of the procedure is acceptable as long as comprehensive protective measures are deployed in light of the frequent close proximity of critical structures.
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31
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Roth M, Rakers L. Intraoperative Neuromonitoring: Principles and Considerations for Perioperative Nurses. AORN J 2019; 110:11-26. [DOI: 10.1002/aorn.12726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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32
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Affiliation(s)
- Jack W. Jennings
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, Siteman Cancer Center, 510 S Kingshighway Blvd, St Louis, MO 63110
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Abstract
Image-guided, minimally invasive, percutaneous thermal ablation of bone metastases has unique advantages compared with surgery or radiation therapy. Thermal ablation of osseous metastases may result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This article will describe current thermal ablation techniques utilized to treat bone metastases, summarize contemporary evidence supporting such thermal ablation treatments, and outline an approach to percutaneous ablative treatment.
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Yevich S, Odisio BC, Sheth R, Tselikas L, de Baère T, Deschamps F. Integrated CT-Fluoroscopy Equipment: Improving the Interventional Radiology Approach and Patient Experience for Treatment of Musculoskeletal Malignancies. Semin Intervent Radiol 2018; 35:229-237. [PMID: 30402005 DOI: 10.1055/s-0038-1669962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Integrated CT-fluoroscopy equipment augments the comprehensive approach to the treatment of musculoskeletal (MSK) malignancy by interventional radiology techniques. As the role of minimally invasive treatment expands to meet the highly variable presentation of MSK malignancy, creative solutions to treatment challenges are required to improve locoregional tumor control and durability of pain palliation. Challenges to effective treatment can often be attributed to a combination of aggressive tumor biology, large size, forbidding location, and adverse vascularity. In these cases, a tailored treatment approach may necessitate the application of multiple interventional radiology (IR) techniques that require different image guidance capabilities. Integrated CT-fluoroscopy equipment provides the means to leverage both imaging modalities within the same procedural setting to facilitate the simultaneous application of multiple synergistic treatments and protective measures. This article examines the potential role of hybrid units in the IR treatment of challenging MSK malignancies as a means to empower a paradigm transition for a more comprehensive and patient-tailored approach.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno C Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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Kurup AN, Schmit GD, Atwell TD, Sviggum EB, Castaneda WR, Rose PS, Callstrom MR. Palliative Percutaneous Cryoablation and Cementoplasty of Acetabular Metastases: Factors Affecting Pain Control and Fracture Risk. Cardiovasc Intervent Radiol 2018; 41:1735-1742. [PMID: 29881934 DOI: 10.1007/s00270-018-1998-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/21/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To characterize the response of patients with acetabular metastases following combined cryoablation and cementoplasty (CCC) for pain palliation and fracture risk reduction, based on completeness of ablation and the presence of pre-existing pathologic fracture. MATERIALS AND METHODS Thirty-nine consecutive acetabular CCC procedures were performed in 37 patients (24 M:13F, age 66 ± 8 years). Pain was assessed using a 0-10 numeric rating scale. Development of new or progression of pre-existing fractures and local tumor progression (LTP) were determined on follow-up imaging. Pain score reduction and fracture development rates were compared by ablation completeness and the presence of pre-existing fractures. RESULTS Twenty-three of 27 (85%) patients with evaluable pain scores had reduced pain, decreasing from 7.5 ± 2.1 to 3.6 ± 2.6 (p < 0.0001). Of 39 tumors, 28 (72%) were completely ablated with no significant difference in pain reduction after complete versus incomplete ablations (p = 0.9387). Six of 30 (20%) patients with follow-up imaging demonstrated new/progressive acetabular fractures. Four of 5 (80%) patients with LTP developed new/progressive fractures compared to 2 of 25 (8%) without tumor progression (p = 0.0003). Pre-existing fracture was not associated with subsequent fracture/fracture progression (p = 0.2986). However, patients with prior acetabular radiation therapy or surgery had increased fractures following treatment (p = 0.0380). CONCLUSION Complete acetabular tumor ablation during CCC was not associated with superior pain relief compared to subtotal ablation but did result in improved fracture stabilization. Pre-treatment pathologic fractures were not associated with fracture progression, but new/progressive fractures were more frequent in patients with prior radiation therapy or surgery.
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Affiliation(s)
- A Nicholas Kurup
- Department of Radiology (ANK, GDS, TDA, MRC), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Grant D Schmit
- Department of Radiology (ANK, GDS, TDA, MRC), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Thomas D Atwell
- Department of Radiology (ANK, GDS, TDA, MRC), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Erik B Sviggum
- Department of Radiology (EBS), Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI, 54703, USA
| | - Wilfrido R Castaneda
- Department of Radiology (WRC), Park Nicollet, 6500 Excelsior Blvd., St. Louis Park, MN, 55426, USA
| | - Peter S Rose
- Department of Orthopedic Surgery (PRS), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Matthew R Callstrom
- Department of Radiology (ANK, GDS, TDA, MRC), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
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Percutaneous Thermal Ablation of Spinal Metastases: Recent Advances and Review. AJR Am J Roentgenol 2018; 210:142-152. [DOI: 10.2214/ajr.17.18205] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kelekis A, Cornelis FH, Tutton S, Filippiadis D. Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty. Semin Intervent Radiol 2017; 34:328-336. [PMID: 29249856 PMCID: PMC5730439 DOI: 10.1055/s-0037-1608747] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.
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Affiliation(s)
- Alexis Kelekis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
| | - Francois H. Cornelis
- Department of Radiology, Université Pierre et Marie Curie, Sorbonne Université, Tenon Hospital, Paris, France
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Department of Radiology and Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dimitrios Filippiadis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
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Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors. Diagn Interv Imaging 2017; 98:635-644. [DOI: 10.1016/j.diii.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
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Abstract
OPINION STATEMENT Percutaneous thermal ablation, including microwave ablation (MWA), radiofrequency ablation (RFA), and cryoablation, is a well-established focal treatment option for primary and metastatic malignancies. While published literature specific to ablation of sarcomas is relatively lacking compared with non-sarcomatous malignancies, what is available is promising. In situations where a focal treatment option is desired, strong consideration should be given to percutaneous thermal ablation, in addition to surgery and radiation therapy. A significant advantage of percutaneous thermal ablation over surgery and radiation includes the repeatability of ablation, as there is no absolute limit on the number of times an ablation can be performed. Compared with surgery, ablation offers the potential of decreased recovery time, a less invasive procedure, and is often performed in patients deemed not medically fit for surgery.
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Abstract
In the last decade, percutaneous treatment of musculoskeletal (MSK) tumors has become more established in routine clinical care while also undergoing a number of advancements. Ablative techniques to palliate painful skeletal metastases have gained wide acceptance, while goals for ablation have evolved to include local control of oligometastases and desmoid tumors. Bone consolidation or augmentation is now frequently used in conjunction with or instead of ablation of skeletal tumors to stabilize pathologic fractures or prevent further morbidity that could result from fractures caused by tumor progression. These procedures have traditionally been performed with cement injection, although additional percutaneous consolidation or stabilization devices have been developed. Techniques to monitor the ablation zone and adjacent structures intraprocedurally are now applied to increase the number of tumors amenable to treatment. These include methods to depict, displace, or monitor critical structures adjacent to targeted MSK tumors. Finally, the role of ablation in the comprehensive care of patients with MSK tumors continues to change with the evolving triage of patients between radiation therapy, surgical resection and stabilization, and percutaneous ablative and consolidative management.
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McArthur TA, Narducci CA, Lander PH, Lopez-Ben R. Percutane Image-Guided Cryoablation of Painful Osseous Metastases: A Retrospective Single-Center Review. Curr Probl Diagn Radiol 2017; 46:282-287. [DOI: 10.1067/j.cpradiol.2016.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/24/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
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Filippiadis D, Mavrogenis AF, Mazioti A, Palialexis K, Megaloikonomos PD, Papagelopoulos PJ, Kelekis A. Metastatic bone disease from breast cancer: a review of minimally invasive techniques for diagnosis and treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:729-736. [PMID: 28597402 DOI: 10.1007/s00590-017-1986-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 01/20/2023]
Abstract
Skeletal-related events in patients with metastatic bone disease include intractable severe pain, pathologic fracture, spinal cord and nerve compression, hypercalcemia and bone marrow aplasia. In patients with breast cancer, the skeleton is the most frequent site for metastases. Treatment options for metastatic bone disease in these patients include bisphosphonates, chemotherapeutic agents, opioids, hormonal therapy, minimally invasive/interventional and surgical techniques. Interventional oncology techniques for breast cancer patients with bone metastases include diagnostic (biopsy) and therapeutic (palliative and curative) approaches. In the latter, percutaneous ablation, augmentation and stabilization are included. The purpose of this article is to describe the basic concepts of biopsy, ablation, embolization and peripheral skeleton augmentation techniques in patients with metastatic bone disease from breast carcinoma. The necessity for a tailored approach applying different techniques for different cases and locations will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Alexis Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
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Gemmete JJ. Is an Intact Posterior Vertebral Body Cortex Protective for Percutaneous Ablation? AJNR Am J Neuroradiol 2017; 38:1660-1661. [PMID: 28572151 DOI: 10.3174/ajnr.a5235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J J Gemmete
- University of Michigan Hospitals Ann Arbor, Michigan
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Wallace AN, Hillen TJ, Friedman MV, Zohny ZS, Stephens BH, Greco SC, Talcott MR, Jennings JW. Percutaneous Spinal Ablation in a Sheep Model: Protective Capacity of an Intact Cortex, Correlation of Ablation Parameters with Ablation Zone Size, and Correlation of Postablation MRI and Pathologic Findings. AJNR Am J Neuroradiol 2017; 38:1653-1659. [PMID: 28572150 DOI: 10.3174/ajnr.a5228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Despite the growing use of percutaneous ablation therapy for the treatment of metastatic spine disease, several issues have yet to be fully addressed. Our aims were to determine whether the vertebral body cortex protects against ablation-induced spinal cord injury; correlate radiofrequency, cryo-, and microwave ablation parameters with resulting spinal ablation zone dimensions and describe normal spinal marrow postablation changes on MR imaging. MATERIALS AND METHODS Ten thoracolumbar vertebrae in 3 sheep were treated with radiofrequency ablation, cryoablation, or microwave ablation under fluoroscopic guidance. Technique parameters were chosen to produce ablation zones that exceeded the volume of the vertebral bodies in sheep 1 and were confined to the vertebrae in sheep 2 and 3. Expected ablation zone dimensions were based on data provided by the device manufacturers. Postablation MR imaging was performed at 48 hours (sheep 1) or 7 days (sheep 2 and 3). RESULTS In sheep 1, cryoablation and microwave ablations extended into the spinal canal and caused histologically confirmed neurologic injury, but radiofrequency ablation did not. The mean difference between the lengths of the radiofrequency ablation zone dimensions measured on gross pathology compared with those expected was 9.6 ± 4.1 mm. The gross pathologic cryo- and microwave ablation zone dimensions were within 1 mm of those expected. All modalities produced a nonenhancing ablation zone with a rim of enhancement, corresponding histologically to marrow necrosis and hemorrhagic congestion. CONCLUSIONS An intact cortex appears to protect against radiofrequency ablation-induced spinal cord injury, but not against non-impedance-based modalities. Ablation dimensions produced by microwave and cryoablation are similar to those expected, while radiofrequency ablation dimensions are smaller. Ablation of normal marrow produces a rim of enhancement at the margin of the ablation zone on MR imaging.
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Affiliation(s)
- A N Wallace
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
| | - T J Hillen
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
| | - M V Friedman
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
| | - Z S Zohny
- Department of Neurosurgery (Z.S.Z., B.H.S.)
| | | | - S C Greco
- Division of Comparative Medicine (S.C.G., M.R.T.), Washington University, St Louis, Missouri
| | - M R Talcott
- Division of Comparative Medicine (S.C.G., M.R.T.), Washington University, St Louis, Missouri
| | - J W Jennings
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
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Lea W, Tutton S. Decision Making: Osteoplasty, Ablation, or Combined Therapy for Spinal Metastases. Semin Intervent Radiol 2017; 34:121-131. [PMID: 28579680 DOI: 10.1055/s-0037-1602707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Metastatic disease involving the spine and pelvis is common, often resulting in significant pain and disability. Several percutaneous interventions have been described, including osteoplasty, ablation, and screw fixation, that when used alone or in combination can significantly reduce pain and disability from metastatic bone disease. Although it is possible to make a significant impact in patient care with basic principles and techniques, certain advanced techniques can extend the application of percutaneous interventions while minimizing morbidity.
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Affiliation(s)
- William Lea
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
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Tomasian A, Wallace AN, Jennings JW. Benign Spine Lesions: Advances in Techniques for Minimally Invasive Percutaneous Treatment. AJNR Am J Neuroradiol 2017; 38:852-861. [PMID: 28183835 DOI: 10.3174/ajnr.a5084] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Minimally invasive percutaneous imaging-guided techniques have been shown to be safe and effective for the treatment of benign tumors of the spine. Techniques available include a variety of tumor ablation technologies, including radiofrequency ablation, cryoablation, microwave ablation, alcohol ablation, and laser photocoagulation. Vertebral augmentation may be performed after ablation as part of the same procedure for fracture stabilization or prevention. Typically, the treatment goal in benign spine lesions is definitive cure. Painful benign spine lesions commonly encountered in daily practice include osteoid osteoma, osteoblastoma, vertebral hemangioma, aneurysmal bone cyst, Paget disease, and subacute/chronic Schmorl node. This review discusses the most recent advancement and use of minimally invasive percutaneous therapeutic options for the management of benign spine lesions.
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Affiliation(s)
- A Tomasian
- From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
| | - A N Wallace
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
| | - J W Jennings
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
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Percutaneous Image-Guided Cryoablation as Second-Line Therapy of Soft-Tissue Venous Vascular Malformations of Extremities: A Prospective Study of Safety and 6-Month Efficacy. Cardiovasc Intervent Radiol 2017; 40:1358-1366. [PMID: 28361195 DOI: 10.1007/s00270-017-1636-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the safety and short-term efficacy of percutaneous image-guided cryoablation performed as second-line therapy of venous vascular malformations (VVM) of extremities. MATERIALS AND METHODS In this non-blinded, no-randomized trial, cryoablation was proposed in 14 patients presenting with symptomatic VVM for recurrences after treatment. Eligibility criteria were: cryoablation feasible, localization at least 5 mm from skin and nerves, absence of contra-indication for anesthesia. Safety was evaluated by the common terminology criteria for adverse events (AE). Clinical response was assessed by evaluating pain at day 7, month 2 and 6 using visual analog scale; quality of life before cryoablation and at 2 and 6 months after using questionnaire. Evolution of volume was evaluated by MRI at 6 months. Comparison was performed using the Wilcoxon test. RESULTS A technical success was observed in all cases. While 11 patients (78.6%) presented AE (13 grade 1-2 and 3 grade 3), only two severe AE (grade 3) related to cryoablation occurred in two patients (14.3%) during the 6-month follow-up: one immediate sciatic paralysis and one delayed paresthesia. A clinical response was observed in 12 patients (85.7%) at 6 months. Pain decreased significantly from 42.5 ± 14.2 mm before the intervention to 11.8 ± 17.9 mm at 6 months (P = 0.002). A significant decrease in the mean volume from 12.8 ± 14.3 to 3 ± 2.7 cm3 was observed at 6 months (P = 0.002). CONCLUSION Percutaneous cryoablation is a promising alternative treatment for sclerotherapy-resistant venous malformations. However, to improve safety, careful patient selection and treatment planning will be mandatory.
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Kurup AN, Callstrom MR. Expanding role of percutaneous ablative and consolidative treatments for musculoskeletal tumours. Clin Radiol 2017; 72:645-656. [PMID: 28363660 DOI: 10.1016/j.crad.2017.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/02/2017] [Accepted: 02/16/2017] [Indexed: 01/21/2023]
Abstract
Interventional approaches to musculoskeletal tumours have significantly changed over the last several years, and new treatments continue to be developed. All ablative modalities are currently applied to the treatment of bone tumours, including radiofrequency, cryo-, microwave, and laser ablation devices. Indications for ablation of bone and soft-tissue tumours have expanded beyond palliation of painful bone metastases and eradication of osteoid osteomas to the local control of oligometastatic disease from a number of primary tumours and ablation of desmoid tumours. In addition, tools for consolidation of bone tumours at risk of pathological fracture have also expanded. With these developments, ablation has become the primary treatment for osteoid osteomas and, at some institutions, desmoid tumours. It may be the primary or secondary treatment for palliation of painful bone tumours, frequently used in patients with pain refractory to or recurrent after radiation therapy. It is used as a treatment for limited metastatic disease or for metastases that grow disproportionately in patients with multifocal metastases, either in combination with systemic therapy or to reserve systemic therapy and its toxicity for more widespread disease progression. Moreover, percutaneous methods to consolidate bone at risk of fracture have become more commonplace, aided by techniques using materials beyond typical bone cement.
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Affiliation(s)
- A N Kurup
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - M R Callstrom
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Percutaneous Image-Guided Cryoablation of Musculoskeletal Metastases: Pain Palliation and Local Tumor Control. J Vasc Interv Radiol 2016; 27:1788-1796. [DOI: 10.1016/j.jvir.2016.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 12/25/2022] Open
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