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Garnon J, Olivier I, Lecigne R, Fesselier M, Dalili D, Auloge P, Cazzato RL, Jennings J, Koch G, Gangi A. Safety of Thermosensor Insertion in the Midline of the Spinal Canal Anterior to the Dura: A Cadaveric Study. Cardiovasc Intervent Radiol 2021; 44:1986-1993. [PMID: 34523021 DOI: 10.1007/s00270-021-02962-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the safety of the insertion of a blunt-tip thermosensor inside the anterior epidural space using the trans-osseous route in the dorsal spine and the double oblique trans-foraminal approach in the lumbar spine. MATERIALS AND METHODS A total of 10 attempts were made on a 91 years old human specimen. Thermosensors were inserted under fluoroscopic guidance in the anterior part of the spinal canal using various oblique angulations. Surgical dissection was then performed to identify the position of the thermosensor and look for any injury to the dural sac or the spinal cord/cauda equina. RESULTS Nine thermosensors could be deployed successfully in the anterior part of the spinal canal from Th8 to L5 while one attempt (L5 level) failed due to a technical issue on the coaxial needle. On anteroposterior projection, the tip of thermosensor relative to the midline was classified as centered in 5 cases, overcrossing in 3 cases and undercrossing in 1 case. At surgical dissection, the tip of the thermosensor was epidural posterior to the posterior longitudinal ligament in 8 cases and anterior to the longitudinal ligament in 1 case (the undercrossing case). There were 3 tears to the dura, all in the overcrossing group. There was no case of injury to the spinal cord/cauda equina. CONCLUSION Insertion of a thin blunt-tip thermosensor with optimal angulation leads to an epidural post-ligamentous position on the midline without damage to the dural sac. The blunt-tip did not prevent from dural tearing should the insertion overcross the midline.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France.
| | - Irène Olivier
- Department of Neurosurgery, Hôpital de Hautepierre, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France
| | - Romain Lecigne
- Department of Radiology, Hôpital Sud, 16, Boulevard de Bulgarie, 35200, Rennes, France
| | - Melissa Fesselier
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, King's College Hospital NHS Foundation Trust, Strand, London, WC2R 2LS, UK
| | - Pierre Auloge
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France
| | - Jack Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St Louis, MO, 63110, USA
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67096, Strasbourg Cedex, France
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De Tommasi F, Massaroni C, Grasso RF, Carassiti M, Schena E. Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges. SENSORS (BASEL, SWITZERLAND) 2021; 21:5470. [PMID: 34450911 PMCID: PMC8400360 DOI: 10.3390/s21165470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes.
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Affiliation(s)
- Francesca De Tommasi
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Rosario Francesco Grasso
- Unit of Interventional Radiology, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
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Zhang C, Han X, Douglas P, Dai Y, Wang G. Bipolar Radiofrequency Ablation of Spinal Tumors: The Effect of the Posterior Vertebral Cortex Defect on Temperature Distribution in the Spinal Canal. AJNR Am J Neuroradiol 2017; 39:E1-E2. [PMID: 29146717 DOI: 10.3174/ajnr.a5393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- C Zhang
- Department of Bone and Soft Tissue Tumors Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin's Clinical Research Center for Cancer Tianjin, China
| | - X Han
- Department of Bone and Soft Tissue Tumors Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin's Clinical Research Center for Cancer Tianjin, China
| | - P Douglas
- Tianjin Medical University Tianjin, China
| | - Y Dai
- Institute of Robotics and Automatic Information System Tianjin Key Laboratory of Intelligent Robotics College of Computer and Control Engineering, Nankai University Tianjin, China
| | - G Wang
- Department of Bone and Soft Tissue Tumors Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin's Clinical Research Center for Cancer Tianjin, China
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Zarghooni K, Westermann L, Sobottke R, Röllinghoff M, Bredow J, Siewe J, Eysel P, Scheyerer MJ. Fracture risk of vertebral bodies after cryosurgery using a miniature cryoprobe: A biomechanical in-vitro analysis on human bones. Technol Health Care 2016; 25:343-351. [PMID: 27886022 DOI: 10.3233/thc-161277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Due to spinal instability and compressive neurologic deficits surgical management is sometimes necessary in patients with metastatic spinal lesions. However, in some cases open surgery is not possible and minimally invasive procedures, like cryoablation, are needed. The aim of the current study was to investigate whether a miniature cryoprobe provides adequate tissue cooling in vertebrae and to evaluate the direct impact of cryosurgery on vertebral body stability. MATERIALS AND METHODS Twelve thoracic vertebral bodies were harvested from fresh cadavers. After documenting bone density cryoablation was performed in six vertebral bodies according to a standardized procedure. Afterwards temperature inside the vertebral body and maximum breaking force were measured in the control and experimental groups. RESULTS Required temperature of -50° was reached in all areas. There was a significant correlation between maximum breaking force and measured bone density (p= 0.001). Mean breaking force within the experimental group was 5047 N (SD = 2955 N) compared to 4458 N (SD = 2554 N) in the control group. There were no observable differences in maximum breaking force between both groups. CONCLUSION Miniature cryoprobe can deliver adequate tissue cooling to -50°C in vertebral bodies. The procedure does not seem to influence breaking force of the treated bones in-vitro. Therefore, using miniature probes cryosurgery may provide a valuable alternative to conventional surgical resection of neoplastic diseases as well as of benign locally aggressive bone tumors.
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Affiliation(s)
- K Zarghooni
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - L Westermann
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - R Sobottke
- Department of Orthopedics, Medical Center City Aachen GmbH, Wuerselen, Germany
| | - M Röllinghoff
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany.,Centre for Orthopaedics, University Medical Centre, Halle (Saale), Germany
| | - J Bredow
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - J Siewe
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - P Eysel
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
| | - M J Scheyerer
- Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
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