skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Feasibility of Intraoperative Nerve Monitoring in Preventing Thermal Damage to the “Nerve at Risk” During Image-Guided Ablation of Tumors

Abstract

PurposeTo assess feasibility of intraoperative neurophysiologic monitoring (IONM) during image-guided, percutaneous thermal ablation of tumors.Materials and MethodsFrom February 2009 to October 2013, a retrospective review of all image-guided percutaneous thermal ablation interventions using IONM was performed and data was compiled using electronic medical records and imaging studies.ResultsTwelve patients were treated in 13 ablation interventions. In 4 patients, real-time feedback from the monitoring neurologist was used to adjust applicator placement and ablation settings. IONM was technically feasible in all procedures and there were no complications related to monitoring or ablation. All nerves at risk remained intact and of the 11 patients who could be followed, none developed new nerve deficit up to a minimum of 2 months after ablation.ConclusionIONM is safe and feasible for use during image-guided thermal ablation of tumors in the vicinity of nerves. Outcomes in this study demonstrate its potential utility in image-guided ablation interventions.

Authors:
; ; ; ;  [1]
  1. Memorial Sloan-Kettering Cancer Center (United States)
Publication Date:
OSTI Identifier:
22642509
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 6; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; BIOMEDICAL RADIOGRAPHY; DAMAGE; ELECTRIC UTILITIES; GAS UTILITIES; HAZARDS; IMAGES; MEDICAL RECORDS; NEOPLASMS; NERVES; PATIENTS; REVIEWS

Citation Formats

Marshall, Richard H., E-mail: rmars1@lsuhsc.edu, Avila, Edward K., E-mail: avilae@mskcc.org, Solomon, Stephen B., E-mail: solomons@mskcc.org, Erinjeri, Joseph P., E-mail: erinjerj@mskcc.org, and Maybody, Majid, E-mail: maybody@mskcc.org. Feasibility of Intraoperative Nerve Monitoring in Preventing Thermal Damage to the “Nerve at Risk” During Image-Guided Ablation of Tumors. United States: N. p., 2016. Web. doi:10.1007/S00270-015-1287-9.
Marshall, Richard H., E-mail: rmars1@lsuhsc.edu, Avila, Edward K., E-mail: avilae@mskcc.org, Solomon, Stephen B., E-mail: solomons@mskcc.org, Erinjeri, Joseph P., E-mail: erinjerj@mskcc.org, & Maybody, Majid, E-mail: maybody@mskcc.org. Feasibility of Intraoperative Nerve Monitoring in Preventing Thermal Damage to the “Nerve at Risk” During Image-Guided Ablation of Tumors. United States. doi:10.1007/S00270-015-1287-9.
Marshall, Richard H., E-mail: rmars1@lsuhsc.edu, Avila, Edward K., E-mail: avilae@mskcc.org, Solomon, Stephen B., E-mail: solomons@mskcc.org, Erinjeri, Joseph P., E-mail: erinjerj@mskcc.org, and Maybody, Majid, E-mail: maybody@mskcc.org. 2016. "Feasibility of Intraoperative Nerve Monitoring in Preventing Thermal Damage to the “Nerve at Risk” During Image-Guided Ablation of Tumors". United States. doi:10.1007/S00270-015-1287-9.
@article{osti_22642509,
title = {Feasibility of Intraoperative Nerve Monitoring in Preventing Thermal Damage to the “Nerve at Risk” During Image-Guided Ablation of Tumors},
author = {Marshall, Richard H., E-mail: rmars1@lsuhsc.edu and Avila, Edward K., E-mail: avilae@mskcc.org and Solomon, Stephen B., E-mail: solomons@mskcc.org and Erinjeri, Joseph P., E-mail: erinjerj@mskcc.org and Maybody, Majid, E-mail: maybody@mskcc.org},
abstractNote = {PurposeTo assess feasibility of intraoperative neurophysiologic monitoring (IONM) during image-guided, percutaneous thermal ablation of tumors.Materials and MethodsFrom February 2009 to October 2013, a retrospective review of all image-guided percutaneous thermal ablation interventions using IONM was performed and data was compiled using electronic medical records and imaging studies.ResultsTwelve patients were treated in 13 ablation interventions. In 4 patients, real-time feedback from the monitoring neurologist was used to adjust applicator placement and ablation settings. IONM was technically feasible in all procedures and there were no complications related to monitoring or ablation. All nerves at risk remained intact and of the 11 patients who could be followed, none developed new nerve deficit up to a minimum of 2 months after ablation.ConclusionIONM is safe and feasible for use during image-guided thermal ablation of tumors in the vicinity of nerves. Outcomes in this study demonstrate its potential utility in image-guided ablation interventions.},
doi = {10.1007/S00270-015-1287-9},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 39,
place = {United States},
year = 2016,
month = 6
}
  • IntroductionSpastic patients often seek neurolysis, the permanent destruction of the sciatic nerve, for better pain management. MRI-guided high-intensity focused ultrasound (MRgHIFU) may serve as a noninvasive alternative to the prevailing, more intrusive techniques. This in vivo acute study is aimed at performing sciatic nerve neurolysis using a clinical MRgHIFU system.MethodsThe HIFU ablation of sciatic nerves was performed in swine (n = 5) using a HIFU system integrated with a 3 T MRI scanner. Acute lesions were confirmed using T1-weighted contrast-enhanced (CE) MRI and histopathology using hematoxylin and eosin staining. The animals were euthanized immediately following post-ablation imaging.ResultsReddening and mild thickening of themore » nerve and pallor of the adjacent muscle were seen in all animals. The HIFU-treated sections of the nerves displayed nuclear pyknosis of Schwann cells, vascular hyperemia, perineural edema, hyalinization of the collagenous stroma of the nerve, myelin sheet swelling, and loss of axons. Ablations were visible on CE MRI. Non-perfused volume of the lesions (5.8–64.6 cc) linearly correlated with estimated lethal thermal dose volume (4.7–34.2 cc). Skin burn adjacent to the largest ablated zone was observed in the first animal. Bilateral treatment time ranged from 55 to 138 min, and preparation time required 2 h on average.ConclusionThe acute pilot study in swine demonstrated the feasibility of a noninvasive neurolysis of the sciatic nerve using a clinical MRgHIFU system. Results revealed that acute HIFU nerve lesions were detectable on CE MRI, gross pathology, and histology.« less
  • Aims. In this article we present our experience with radiofrequency ablation (RFA) in the treatment of 105 renal tumors. Materials and Methods. RFA was performed on 105 renal tumors in 97 patients, with a mean tumor size of 32 mm (11-68 mm). The mean patient age was 71.7 years (range, 36-89 years). The ablations were carried out under ultrasound (n = 43) or CT (n = 62) guidance. Imaging follow-up was by contrast-enhanced CT within 10 days and then at 6-monthly intervals. Multivariate analysis was performed to determine variables associated with procedural outcome. Results. Eighty-three tumors were completely treated atmore » a single sitting (79%). Twelve of the remaining tumors were successfully re-treated and a clinical decision was made not to re-treat seven patients. A patient with a small residual crescent of tumor is under follow-up and may require further treatment. In another patient, re-treatment was abandoned due to complicating pneumothorax and difficult access. One patient is awaiting further re-treatment. The overall technical success rate was 90.5%. Multivariate analysis revealed tumor size to be the only significant variable affecting procedural outcome. (p = 0.007, Pearson {chi}{sup 2}) Five patients had complications. There have been no local recurrences. Conclusion. Our experience to date suggests that RFA is a safe and effective, minimally invasive treatment for small renal tumors.« less
  • Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocainemore » solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1-10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.« less
  • We evaluated the safety and efficacy of image-guided radiofrequency ablation (RFA) using a triple-spiral-shaped electrode needle for unresectable primary or metastatic hepatic tumors. Thirty-four patients with 46 index tumors were treated. Ablation zone, morbidity, and complications were assessed. The lesions were completely ablated with an ablative margin of about 1 cm. Five patients (14.7%) with a lesion larger than 4.5 cm had local tumor progression after 1 month and were retreated. Hemothorax, as a major complication, occurred in 1 of 34 patients (3.0%) or 1 of 46 lesions ablated (2.2%). RFA using this new electrode needle can be effective inmore » the treatment of large unresectable hepatic tumors.« less
  • We obtained clear and reproducible MR fluoroscopic images and temperature maps for MR image-guided microwave ablation of liver tumors under general anesthesia without suspending the artificial ventilation. Respiratory information was directly obtained from air-way pressure without a sensor on the chest wall. The trigger signal started scanning of one whole image with a spoiled gradient echo sequence. The delay time before the start of scanning was adjusted to acquire the data corresponding to the k-space center at the maximal expiratory phase. The triggered images were apparently clearer than the nontriggered ones and the location of the liver was consistent, whichmore » made targeting of the tumor easy. MR temperature images, which were highly susceptible to the movement of the liver, during microwave ablation using a proton resonance frequency method, could be obtained without suspending the artificial ventilation. Respiratory triggering technique was found to be useful for MR fluoroscopic images and MR temperature monitoring in MR-guided microwave ablation of liver tumors under general anesthesia.« less