TY - JOUR
T1 - Neuroanatomic considerations in percutaneous tumor ablation
AU - Kurup, A. Nicholas
AU - Morris, Jonathan M.
AU - Schmit, Grant D.
AU - Atwell, Thomas D.
AU - Weisbrod, Adam J.
AU - Murthy, Naveen S.
AU - Woodrum, David A.
AU - Callstrom, Matthew R.
PY - 2013
Y1 - 2013
N2 - Percutaneous ablation is increasingly being used as focal therapy for tumors in the chest, abdomen, and pelvis, including tumors in proximity to neural structures. To ensure that tumor ablation is performed safely, knowledge of the regional neuroanatomy is particularly important because most relevant nerves are not visualized with the conventional imaging techniques used to guide ablation procedures. Familiarity with the expected course of nerves in commonly targeted areas is helpful in preventing inadvertent nerve injury and in accurately informing the patient of potential risks. In the chest and shoulder girdle, the brachial plexus as well as the phrenic, recurrent laryngeal, intercostal-subcostal, long thoracic, dorsal scapular, and suprascapular nerves may be encountered. Vulnerable neural structures in the abdomen and pelvis arise from the lumbar and sacral plexuses and include the femoral, obturator, sciatic, and pudendal nerves. Nerve protection and monitoring techniques should be used, when appropriate, to minimize the risk of neural injury during percutaneous tumor ablation and depend on the vulnerable nerve, the location of the targeted tumor, and the ablation device used for treatment. Nerves may be protected using displacement techniques, including instillation of air or fluid, insertion and insuffation of angioplastic or endoscopic balloons, and mechanical manipulation of the ablation device. Nerves may be monitored with cross-sectional imaging evaluation of the critical nerve or ablation zone, or with functional evaluation using electromyographic equipment or focused clinical examination.
AB - Percutaneous ablation is increasingly being used as focal therapy for tumors in the chest, abdomen, and pelvis, including tumors in proximity to neural structures. To ensure that tumor ablation is performed safely, knowledge of the regional neuroanatomy is particularly important because most relevant nerves are not visualized with the conventional imaging techniques used to guide ablation procedures. Familiarity with the expected course of nerves in commonly targeted areas is helpful in preventing inadvertent nerve injury and in accurately informing the patient of potential risks. In the chest and shoulder girdle, the brachial plexus as well as the phrenic, recurrent laryngeal, intercostal-subcostal, long thoracic, dorsal scapular, and suprascapular nerves may be encountered. Vulnerable neural structures in the abdomen and pelvis arise from the lumbar and sacral plexuses and include the femoral, obturator, sciatic, and pudendal nerves. Nerve protection and monitoring techniques should be used, when appropriate, to minimize the risk of neural injury during percutaneous tumor ablation and depend on the vulnerable nerve, the location of the targeted tumor, and the ablation device used for treatment. Nerves may be protected using displacement techniques, including instillation of air or fluid, insertion and insuffation of angioplastic or endoscopic balloons, and mechanical manipulation of the ablation device. Nerves may be monitored with cross-sectional imaging evaluation of the critical nerve or ablation zone, or with functional evaluation using electromyographic equipment or focused clinical examination.
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U2 - 10.1148/rg.334125141
DO - 10.1148/rg.334125141
M3 - Article
C2 - 23842979
AN - SCOPUS:84880078982
SN - 0271-5333
VL - 33
SP - 1195
EP - 1215
JO - Radiographics
JF - Radiographics
IS - 4
ER -