Advertisement

CardioVascular and Interventional Radiology

, Volume 41, Issue 2, pp 350–354 | Cite as

Epidural Balloon Placement for Protection of the Spinal Canal During Cryoablation of Paraspinal Lesions

  • Jeffrey Forris Beecham Chick
  • Ravi N. Srinivasa
  • Evan Johnson
  • Matthew L. Osher
  • Anthony Hage
  • Joseph J. Gemmete
Case Report

Abstract

Ablation of paraspinal lesions close to the spinal canal and neuroforamina requires protective measures in order to protect the spinal cord and nerve roots. Various methods of protection have been previously described including infusion of saline and CO2. Regardless, neuromonitoring should be adjunctively performed when ablating spinal lesions close to neuronal structures. Balloon protection has been previously described during ablation of renal masses. The benefit of balloon protection in paraspinal mass ablation is it physically displaces the nerve roots as opposed to CO2 or saline which has the potential to insulate but because of its aerosolized or fluid nature may or may not provide definitive continuous protection throughout an ablation. This report details three paraspinal lesions, two of which were successfully ablated with the use of a balloon placed in the epidural space to provide protection to the spinal cord and nerve roots.

Keywords

Epidural balloon protection Cryoablation Spinal tumor Paraspinal mass 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Tomasian A, Wallace A, Northrup B, et al. Spine Cryoablation: pain palliation and local tumor control for vertebral metastases. AJNR Am J Neuroradiol. 2016;37(1):189–95.CrossRefPubMedGoogle Scholar
  2. 2.
    Nakatsuka A, Yamakado K, Takaki H, et al. Percutaneous radiofrequency ablation of painful spinal tumors adjacent to the spinal cord with real-time monitoring of spinal canal temperature: a prospective study. Cardiovasc Interv Radiol. 2009;32(1):70–5.CrossRefGoogle Scholar
  3. 3.
    Gangi A, Alizadeh H, Wong L, et al. Osteoid osteoma: percutaneous laser ablation and follow-up in 114 patients. Radiology. 2007;242(1):293–301.CrossRefPubMedGoogle Scholar
  4. 4.
    Doctor JR, Solanski SL, Patil VP, et al. Novel use of epidural catheter: air injection for neuroprotection during radiofrequency ablation of spinal osteoid osteoma. Saudi J Anaesth. 2016;10(3):347–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tan AL, Deutsch H. Thermal injury of thoracic spinal cord after percutaneous cryoablation of spinal tumor—when needles are more dangerous than the knife. Br J Neurosurg. 2015;29(3):443.CrossRefPubMedGoogle Scholar
  6. 6.
    Wallace AN, Hillen TJ, Friedman MV, et al. 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(8):1653–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Gibbs IC. Spinal and paraspinal lesions: the role of stereotactic body radiotherapy. Front Radiat Ther Oncol. 2007;40:407–14.CrossRefPubMedGoogle Scholar
  8. 8.
    Callstrom MR, Charboneau JW, Goetz MP, et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skelet Radiol. 2006;35(1):1–15.CrossRefGoogle Scholar
  9. 9.
    Havez M, Lippa N, Al-Ammari S, et al. Percutaneous image-guided cryoablation in inoperable extra-abdominal desmoid tumors: a study of tolerability and efficacy. Cardiovasc Interv Radiol. 2014;37(6):1500–6.CrossRefGoogle Scholar
  10. 10.
    de Freitas RM, de Menezes MR, Cerri GG, et al. Sclerotic vertebral metastases: pain palliation using percutaneous image-guided cryoablation. Cardiovasc Interv Radiol. 2011;34(Suppl 2):S294–9.CrossRefGoogle Scholar
  11. 11.
    Vanderschueren GM, Taminiau AH, Obermann WR, et al. Osteoid osteoma: clinical results with thermocoagulation. Radiology. 2002;224(1):82–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Dupuy DE, Hong R, Oliver B, et al. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. Am J Roentgenol. 2000;175(5):1263–6.CrossRefGoogle Scholar
  13. 13.
    Nuwer MR, Dawson EG, Carlson LG, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol/Evoked Potentials Sect. 1995;96(1):6–11.CrossRefGoogle Scholar
  14. 14.
    Vanický I, Marsala M, Galik J, et al. Epidural perfusion cooling protection against protracted spinal cord ischemia in rabbits. J Neurosurg. 1993;79(5):736–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Casas CE, Herrera LP, Prusmack C, et al. Effects of epidural hypothermic saline infusion on locomotor outcome and tissue preservation after moderate thoracic spinal cord contusion in rats. J Neurosurg Spine. 2005;2(3):308–18.CrossRefPubMedGoogle Scholar
  16. 16.
    Vanicky I, Urdzikova L, Saganova K, et al. A simple and reproducible model of spinal cord injury induced by epidural balloon inflation in the rat. J Neurotrauma. 2001;18(12):1399–407.CrossRefPubMedGoogle Scholar
  17. 17.
    Lim JH, Jung CS, Byeon YE, et al. Establishment of a canine spinal cord injury model induced by epidural balloon compression. J Vet Sci. 2007;8(1):89–94.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  • Jeffrey Forris Beecham Chick
    • 1
  • Ravi N. Srinivasa
    • 1
  • Evan Johnson
    • 1
  • Matthew L. Osher
    • 1
  • Anthony Hage
    • 1
  • Joseph J. Gemmete
    • 1
  1. 1.Department of Radiology, Division of Vascular and Interventional RadiologyUniversity of Michigan Health Systems, Michigan MedicineAnn ArborUSA

Personalised recommendations