Skip to main content
SpringerLink
Log in

Pneumodissection for skin protection in image-guided cryoablation of superficial musculoskeletal tumours

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

Pneumodissection is described as a simple method for preventing skin injury during cryoablation of superficial musculoskeletal tumours.

Methods

Superficial tumour cryoablations performed from 2009 to 2015 were retrospectively reviewed. Pneumodissection was performed in 13 patients when the shortest tumour-skin distance was less than 25 mm. Indications were pain palliation (n = 9) and local tumour control (n = 4). Patients, target tumours, technical characteristics and complications up to 60 days post ablation were reviewed. The ice ball-skin distances with and without pneumodissection were compared by a paired t-test and further assessed for association with covariates using ANCOVA.

Results

Technical success for ablation was 12 of 13. The mean shortest tumour-skin distance was 15.0 mm (3.2–24.5 mm). The mean thickness of pneumodissection was 9.6 mm (5.2–16.6 mm) resulting in mean elevation of skin of 3.4 mm (1.2–5.3 mm). Mean shortest ice ball-skin distance after pneumodissection was 10.5 mm (4.2–19.7 mm). No infection or systemic air embolism was noted. No intraprocedural frostbite was observed.

Conclusion

Pneumodissection is feasible, effective and safe in protecting the skin during image-guided cryoablation of superficial tumours.

Key Points

• Frostbite during image-guided cryoablation of superficial tumours is commonly under-reported.

• Frostbites are painful and may introduce infection into the superficial ablation zone.

• Warm compress, saline and CO 2 have shortcomings in protecting the skin.

• Pneumodissection is free, readily available, easy to use and safe and effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Buy X, Tok CH, Szwarc D, Bierry G, Gangi A (2009) Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring. Cardiovasc Intervent Radiol 32:529–534

    Article  PubMed  Google Scholar 

  2. Filippiadis DK, Tutton S, Maxioti A, Kelekis A (2014) Percutaneous image-guided ablation of bone and soft tissue tumors: a review of available techniques and protective measures. Insights Imaging 5:339–346

    Article  PubMed  PubMed Central  Google Scholar 

  3. Filippiadis DK, Maxioti A, Velonakis G et al (2013) Percutaneous image guided ablation of bone and soft tissue tumors: how to avoid complications. Scientific Exhibit ESSR. doi:10.1594/esst2013/P-0127

    Google Scholar 

  4. Kurup AN, Callstrom MR (2010) Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Interv Radiol 27:276–284

    Article  Google Scholar 

  5. Rosenthal D, Callstrom MR (2012) Critical review and state of the art in interventional oncology: benign and metastatic disease involving bone. Radiology 262:765–780

    Article  PubMed  Google Scholar 

  6. Callstrom MR, Dupuy DE, Solomon SB et al (2013) Percutaneous image- guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 119:1033–1041

    Article  PubMed  Google Scholar 

  7. Erinjeri JP, Clark TWJ (2010) Cryoablation: mechanism of action and devices. J Vasc Interv Radiol 21:S187–S191

    Article  PubMed  Google Scholar 

  8. Maybody M, Solomon SB (2007) Image-guided percutaneous cryoablation of renal tumors. Tech Vasc Interv Radiol 10:140–148

    Article  PubMed  Google Scholar 

  9. Friedman MV, Hillen TJ, Wessell DE, Hildebolt CF, Jennings JW (2014) Hip chondrolysis and femoral head osteonecrosis: a complication of periacetabular cryoablation. J Vasc Interv Radiol 25:1580–1588

    Article  PubMed  Google Scholar 

  10. Prologo JD, Patel I, Buethe J, Bohnert N (2014) Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol 25:769–775

    Article  PubMed  Google Scholar 

  11. McMenomy BP, Kurup AN, Johnson GB et al (2013) Percutaneous cryoablation of musculoskeletal oligometastatic diseasefor complete remission. J Vasc Interv Radiol 24:207–213

    Article  PubMed  Google Scholar 

  12. Marshall RH, Avila EK, Solomon SB, Erinjeri JP, Maybody M (2016) Feasibility of intraoperative nerve monitoring in preventing thermal damage to the ”nerve at risk” during image guided ablation of tumors. Cardiovasc Intervent Radiol 39(6):875–884

  13. Tsoumakidou G, Buy X, Garnon J, Enescu J, Gangi A (2011) Percutaneous thermal ablation: how to protect the surrounding organs. Tech Vasc Interv Radiol 14:170–176

    Article  PubMed  Google Scholar 

  14. Griauzde J, Gemmete JJ, Farley F (2015) Successful treatment of a musculoskeletal tumor society grade 3 aneurysmal bone cyst with N-butyl cyanoacrylate embolization and percutaneous cryoablation. J Vasc Interv Radiol 26:905–909

    Article  PubMed  Google Scholar 

  15. Worrell JB, Cleary DT (2002) Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery - case studies. AANA J 70:456–461

    PubMed  Google Scholar 

  16. Jones PM, Hewer RD, Wolfenden HD, Thomas PS (2001) Subcutaneous emphysema associated with chest tube drainage. Respirology 6:87–89

    Article  CAS  PubMed  Google Scholar 

  17. Lostoridis E, Tourountzi P, Pouggouras K, Koutsouki S, Lampiri K, Nagy EO (2015) Pneumoscrotum after tracheal intubation. Acta Anaesthesiol Taiwanica 53:44–46

    Article  Google Scholar 

  18. Cefolio RJ, Bryant AS, Maniscalco LM (2008) Management of subcutaneous emphysema after pulmonary resection. Ann Thorac Surg 85:1759–1763, discussion 1764-5

    Article  Google Scholar 

  19. Ovári A, Just T, Dommerich S et al (2014) Conservative management of post-intubation tracheal tears-report of three cases. J Thorac Dis 6:E85–E91

    PubMed  PubMed Central  Google Scholar 

  20. Martí de Gracia M, Gutiérrez FG, Martínez M, Dueñas VP (2009) Subcutaneous emphysema: diagnostic clue in the emergency room. Emerg Radiol 16:343–348

    Article  PubMed  Google Scholar 

  21. Schneider T, Storz K, Dienemann H, Hoffmann H (2007) Management of iatrogenic tracheobronchial injuries: a retrospective analysis of 29 cases. Ann Thorac Surg 83:1960–1964

    Article  PubMed  Google Scholar 

  22. Maurice MJ, Haaga JR, Nakamoto DA, Ponsky LE (2013) Pneumodissection: an alternative protective technique for the percutaneous cryoablation of small renal masses. Urol Int 90:381–383

    Article  PubMed  Google Scholar 

  23. Gandini R, Konda D, Reale CA et al (2008) Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate—outcome in 244 patients. Radiology 246:612–618

    Article  PubMed  Google Scholar 

  24. Fischman AM, Ward TJ, Horn JC et al (2014) Portal vein embolization before right hepatectomy or extended right hepatectomy using sodium tetradecyl sulfate foam: technique and initial results. J Vasc Interv Radiol 25:1045–1053

    Article  PubMed  Google Scholar 

  25. Gandini R, Chiocchi M, Konda D, Pampana E, Fabiano S, Simonetti G (2008) Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam. Cardiovasc Intervent Radiol 31:778–784

    Article  PubMed  Google Scholar 

  26. McCafferty I (2015) Management of low-flow vascular malformations: clinical presentation, classification, patient selection, imaging and treatment. Cardiovasc Intervent Radiol 38:1082–1104

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Majid Maybody, MD. The authors of this manuscript declare relationships with the following companies: None. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

This study has received funding by a Cancer Center Support Grant from the National Cancer Institute (P30 CA008748). Chaya Moskowitz and Meier Hsu kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Majid Maybody, Hooman Yarmohammadi & F. Edward Boas

  2. State University of New York School of Medicine and Biomedical Sciences at Buffalo, Buffalo, NY, USA

    Peter Q. Tang

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Chaya S. Moskowitz & Meier Hsu

Authors
  1. Majid Maybody
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Q. Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chaya S. Moskowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meier Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hooman Yarmohammadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Edward Boas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Majid Maybody.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maybody, M., Tang, P.Q., Moskowitz, C.S. et al. Pneumodissection for skin protection in image-guided cryoablation of superficial musculoskeletal tumours. Eur Radiol 27, 1202–1210 (2017). https://doi.org/10.1007/s00330-016-4456-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4456-6

Keywords

Search

Navigation