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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.

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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.

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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

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

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