Avoiding Complications in Bone and Soft Tissue Ablation

Abstract

As with percutaneous ablation of tumors in the liver, lungs, and kidneys, ablation of bone and non-visceral soft tissue tumors carries risk, primarily from collateral damage to vital structures in proximity to the target tumor. Certain risks are of particular interest when ablating bone and non-visceral soft tissue tumors, namely neural or skin injury, bowel injury, fracture, and gas embolism from damaged applicators. Ablation of large volume tumors also carries special risk. Many techniques may be employed by the interventional radiologist to minimize complications when treating tumors in the musculoskeletal system. These methods include those to depict, displace, or monitor critical structures. Thus, measures to provide thermoprotection may be active, such as careful ablation applicator placement and use of various displacement techniques, as well as passive, including employment of direct temperature, radiographic, or neurophysiologic monitoring techniques. Cementoplasty should be considered in certain skeletal locations at risk of fracture. Patients treated with large volume tumors should be monitored for renal dysfunction and properly hydrated. Finally, ablation applicators should be cautiously placed in the constrained environment of intact bone.

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Correspondence to A. Nicholas Kurup.

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Conflicts of interest

A. N. Kurup has received a research grant from Galil Medical; has received royalties from UpToDate, Inc.; outside the submitted work. J. M. Morrois is a paid consultant for Medtronic; outside the submitted work. M. R. Callstrom has received research grants from General Electric Medical, Thermedical, Galil Medical, and Siemens Medical; has received royalties from UpToDate, Inc.; and is a paid consultant for Covidien, Medtronic, and Perseon Medical; outside the submitted work. All other authors have no potential conflicts of interest to disclose.

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Kurup, A.N., Schmit, G.D., Morris, J.M. et al. Avoiding Complications in Bone and Soft Tissue Ablation. Cardiovasc Intervent Radiol 40, 166–176 (2017). https://doi.org/10.1007/s00270-016-1487-y

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Keywords

  • Ablation
  • Cryoablation
  • Radiofrequency ablation
  • Musculoskeletal
  • Bone tumors