MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases.

Autor: Segal O; National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.; Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Benady A; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel., Pickholz E; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Ovadia JE; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Druckmann I; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel., Dadia S; National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.; Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel., Rath E; Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Albagli A; Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Efrima B; Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel. benefrima@gmail.com.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. benefrima@gmail.com.
Jazyk: angličtina
Zdroj: BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2023 Dec 15; Vol. 24 (1), pp. 969. Date of Electronic Publication: 2023 Dec 15.
DOI: 10.1186/s12891-023-07074-6
Abstrakt: Background: Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs.
Methods: In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded.
Results: All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient's tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively.
Conclusion: These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.
(© 2023. The Author(s).)
Databáze: MEDLINE
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