Spinal cord ischemia after transcatheter artery chemoembolization for hepatocellular carcinoma: A case-report.

Autor:	Hieu LT; Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam., Van Thanh L; Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam. Electronic address: thanhganmat108@gmail.com., Van Quang V; Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam., Khue DK; College of Health Sciences, VinUniversity, Hanoi 100000, Viet Nam. Electronic address: khue.dk@vinuni.edu.vn., Anh NHN; Hepatobiliary and Pancreatic Surgery Department, 108 Military Central Hospital, Hanoi 100000, Viet Nam., Tien DD; Department of Gastroenterology, 175 Military Hospital, Ho Chi Minh City 700000, Viet Nam.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2023 May; Vol. 106, pp. 108258. Date of Electronic Publication: 2023 Apr 24.
DOI:	10.1016/j.ijscr.2023.108258
Abstrakt:	Introduction: Transarterial hepatic chemoembolization (TACE) has been used to treat unresectable hepatocellular carcinoma and has gained widespread acceptance as a treatment for both primary and secondary hepatic malignancies. Case Report: We report a case of 78-year-old male patient with chronic hepatitis B, diagnosed with HCC. He underwent the second TACE, and right after the procedure, the patient abruptly developed bilateral lower extremities motor weakness and sensory impairment below the T10 dermatome. Spinal magnetic resonance imaging showed T2-weighted scans showed increased intramedullary signal strength at the T1-T12 level. The patient received supportive care, ongoing rehabilitation, and steroid pulse therapy. The motor strength remained unchanged, but the sensory deficiencies practically disappeared. Clinical Discussion: The hepatic artery injury or decreased flow at the prior TACE site, which causes collateral recruitment, can explain why spinal cord injury following TACE typically happens after the second or third session. It can occasionally result from accidental embolized spinal branches originating from intercostal or lumbar collateral arteries. In our case, we hypothesize the embolism caused the infarction to the spinal cord travel through the connection between the lateral branches of the right inferior phrenic artery and the intercostal arteries, which supply the spinal cord through the anterior spinal artery. Conclusions: TACE in rare case can have severe complications. A tailored therapeutic strategy, including consideration of a shunt and selection of the vessels utilized for the Lipiodol infusion prior to TACE, is crucial to achieving an optimal end outcome to avert these significant consequences. Competing Interests: Conflict of interest We have no conflicts of interest to disclose. (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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