1
|
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.
Collapse
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
| |
Collapse
|
2
|
Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
| |
Collapse
|
3
|
Management of Unresectable Localized Pelvic Bone Sarcomas: Current Practice and Future Perspectives. Cancers (Basel) 2022; 14:cancers14102546. [PMID: 35626150 PMCID: PMC9139258 DOI: 10.3390/cancers14102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Some locally advanced pelvic bone tumors are deemed unresectable and, as such, not suitable for curative surgery. In this setting, treatment options are generally limited and not unanimous, with decisions being made on an individual basis after multidisciplinary discussion. Ultimately, and notwithstanding the bright prospects raised by novel therapeutic approaches, treatment should be patient-tailored, weighing a panoply of patient- and tumor-related factors. Abstract Bone sarcomas (BS) are rare mesenchymal tumors usually located in the extremities and pelvis. While surgical resection is the cornerstone of curative treatment, some locally advanced tumors are deemed unresectable and hence not suitable for curative intent. This is often true for pelvic sarcoma due to anatomic complexity and proximity to vital structures, making treatment options for these tumors generally limited and not unanimous, with decisions being made on an individual basis after multidisciplinary discussion. Several studies have been published in recent years focusing on innovative treatment options for patients with locally advanced sarcoma not amenable to local surgery. The present article reviews the evidence regarding the treatment of patients with locally advanced and unresectable pelvic BS, with the goal of providing an overview of treatment options for the main BS histologic subtypes involving this anatomic area and exploring future therapeutic perspectives. The management of unresectable localized pelvic BS represents a major challenge and is hampered by the lack of comprehensive and standardized guidelines. As such, the optimal treatment needs to be individually tailored, weighing a panoply of patient- and tumor-related factors. Despite the bright prospects raised by novel therapeutic approaches, the role of each treatment option in the therapeutic armamentarium of these patients requires solid clinical evidence before becoming fully established.
Collapse
|
4
|
Le Corroller T, Vives T, Mattei JC, Pauly V, Guenoun D, Rochwerger A, Champsaur P. Osteoid Osteoma: Percutaneous CT-guided Cryoablation Is a Safe, Effective, and Durable Treatment Option in Adults. Radiology 2021; 302:392-399. [PMID: 34812672 DOI: 10.1148/radiol.2021211100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; P < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.
Collapse
Affiliation(s)
- Thomas Le Corroller
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Thomas Vives
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Jean-Camille Mattei
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Vanessa Pauly
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Daphné Guenoun
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Alexandre Rochwerger
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| | - Pierre Champsaur
- From the Department of Radiology, Hôpitaux Sud, Assistance Publique - Hôpitaux de Marseille, Marseille, France (T.L.C., T.V., D.G., P.C.); Aix Marseille Université, CNRS, ISM UMR 7287, Marseille, France (T.L.C., D.G., P.C.); Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France (J.C.M., A.R.); and Aix Marseille Université, Unité de Recherche EA 3279, Santé Publique et Maladies Chroniques, Marseille, France (V.P.)
| |
Collapse
|
5
|
Bădilă AE, Rădulescu DM, Niculescu AG, Grumezescu AM, Rădulescu M, Rădulescu AR. Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review. Cancers (Basel) 2021; 13:4229. [PMID: 34439383 PMCID: PMC8392383 DOI: 10.3390/cancers13164229] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
In the last decades, the treatment of primary and secondary bone tumors has faced a slow-down in its development, being mainly based on chemotherapy, radiotherapy, and surgical interventions. However, these conventional therapeutic strategies present a series of disadvantages (e.g., multidrug resistance, tumor recurrence, severe side effects, formation of large bone defects), which limit their application and efficacy. In recent years, these procedures were combined with several adjuvant therapies, with different degrees of success. To overcome the drawbacks of current therapies and improve treatment outcomes, other strategies started being investigated, like carrier-mediated drug delivery, bone substitutes for repairing bone defects, and multifunctional scaffolds with bone tissue regeneration and antitumor properties. Thus, this paper aims to present the types of bone tumors and their current treatment approaches, further focusing on the recent advances in new therapeutic alternatives.
Collapse
Affiliation(s)
- Adrian Emilian Bădilă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Dragoș Mihai Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Adrian Radu Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Evolving role of minimally invasive techniques in the management of symptomatic bone metastases. Curr Opin Support Palliat Care 2021; 15:91-98. [PMID: 33905381 DOI: 10.1097/spc.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Bone metastases are responsible for considerable morbidity, which can significantly limit a patient's quality of life. This article aims to review minimally invasive, image-guided locoregional treatments for symptomatic bone metastases as an adjunct to conventional treatment modalities. RECENT FINDINGS Conservative therapy and radiation therapy (RT) can be effective at addressing pain, however, they require time to achieve optimal efficacy and do not address the instability and progressive collapse of pathological fractures. Vertebral and pelvic augmentation with cement enhances structural stability and can prevent progressive collapse and deformity. Ablative therapies, including radiofrequency ablation (RFA), cryoablation, and photodynamic therapy (PDT), induce cellular destruction of tumor tissue. RFA and PDT can be combined with cement augmentation in a single sitting. SUMMARY Minimally invasive image-guided treatments can provide rapid pain relief, enhance mechanical stability, and improve quality of life. These treatments are associated with low complication rates and are suitable for frail patients. They can be used as companion procedures to conventional treatments, or function as an alternative for patients with radioresistant biologies or those with dose limitations from prior RT sessions.
Collapse
|
8
|
Jennings JW, Prologo JD, Garnon J, Gangi A, Buy X, Palussière J, Kurup AN, Callstrom M, Genshaft S, Abtin F, Huang AJ, Iannuccilli J, Pilleul F, Mastier C, Littrup PJ, de Baère T, Deschamps F. Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study. Radiol Imaging Cancer 2021; 3:e200101. [PMID: 33817650 PMCID: PMC8011449 DOI: 10.1148/rycan.2021200101] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 12/04/2020] [Indexed: 04/21/2023]
Abstract
PURPOSE To assess the clinical effectiveness of cryoablation for palliation of painful bone metastases. MATERIALS AND METHODS MOTION (Multicenter Study of Cryoablation for Palliation of Painful Bone Metastases) (ClinicalTrials.gov NCT02511678) was a multicenter, prospective, single-arm study of adults with metastatic bone disease who were not candidates for or had not benefited from standard therapy, that took place from February 2016 to March 2018. At baseline, participants rated their pain using the Brief Pain Inventory-Short Form (reference range from 0 to 10 points); those with moderate to severe pain, who had at least one metastatic candidate tumor for ablation, were included. The primary effectiveness endpoint was change in pain score from baseline to week 8. Participants were followed for 24 weeks after treatment. Statistical analyses included descriptive statistics and logistic regression to evaluate changes in pain score over the postprocedure follow-up period. RESULTS A total of 66 participants (mean age, 60.8 years ± 14.3 [standard deviation]; 35 [53.0%] men) were enrolled and received cryoablation; 65 completed follow-up. Mean change in pain score from baseline to week 8 was -2.61 points (95% CI: -3.45, -1.78). Mean pain scores improved by 2 points at week 1 and reached clinically meaningful levels (more than a 2-point decrease) after week 8; scores continued to improve throughout follow-up. Quality of life improved, opioid doses were stabilized, and functional status was maintained over 6 months. Serious adverse events occurred in three participants. CONCLUSION Cryoablation of metastatic bone tumors provided rapid and durable pain palliation, improved quality of life, and offered an alternative to opioids for pain control.Keywords: Ablation Techniques, Metastases, Pain Management, Radiation Therapy/OncologySupplemental material is available for this article.© RSNA, 2021.
Collapse
|
9
|
Percutaneous cryoablation of osteoblastoma in the proximal femur. Skeletal Radiol 2020; 49:1467-1471. [PMID: 32166366 DOI: 10.1007/s00256-020-03413-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 02/02/2023]
Abstract
A 37-year-old man presented with a 2-year history of left hip pain. Pretherapeutic imaging demonstrated a 4 cm osteoblastoma located in the intertrochanteric region of the proximal femur, surrounded by extensive bone marrow edema. After multidisciplinary meeting, percutaneous cryoablation was decided and performed under computed tomography guidance using three cryoprobes to match the exact size and shape of the tumor, resulting in complete resolution of symptoms. Magnetic resonance imaging follow-up demonstrated resolution of the bone marrow edema pattern and ingrowth of fat at the periphery of the ablation zone consistent with long-term healing of the tumor.
Collapse
|
10
|
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.
Collapse
|