MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases
Abstract 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 fai...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-07074-6 |
| _version_ | 1797388549362810880 |
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| author | Ortal Segal Amit Benady Eliana Pickholz Joshua E. Ovadia Ido Druckmann Solomon Dadia Ehud Rath Assaf Albagli Ben Efrima |
| author_facet | Ortal Segal Amit Benady Eliana Pickholz Joshua E. Ovadia Ido Druckmann Solomon Dadia Ehud Rath Assaf Albagli Ben Efrima |
| author_sort | Ortal Segal |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-08T22:42:25Z |
| format | Article |
| id | doaj.art-7f6a18386ebf41b3911646984abecc16 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-08T22:42:25Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-7f6a18386ebf41b3911646984abecc162023-12-17T12:04:10ZengBMCBMC Musculoskeletal Disorders1471-24742023-12-012411910.1186/s12891-023-07074-6MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 casesOrtal Segal0Amit Benady1Eliana Pickholz2Joshua E. Ovadia3Ido Druckmann4Solomon Dadia5Ehud Rath6Assaf Albagli7Ben Efrima8National Department of Orthopedic Oncology, Tel Aviv Medical CenterSackler Faculty of Medicine, Tel Aviv UniversitySackler Faculty of Medicine, Tel Aviv UniversitySackler Faculty of Medicine, Tel Aviv UniversitySackler Faculty of Medicine, Tel Aviv UniversityNational Department of Orthopedic Oncology, Tel Aviv Medical CenterDivision of Orthopaedic Surgery, Tel Aviv Medical CenterDivision of Orthopaedic Surgery, Tel Aviv Medical CenterDivision of Orthopaedic Surgery, Tel Aviv Medical CenterAbstract 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.https://doi.org/10.1186/s12891-023-07074-6MRI-based navigationFiducial markersPercutaneous CRADesmoid Tumor3D planning |
| spellingShingle | Ortal Segal Amit Benady Eliana Pickholz Joshua E. Ovadia Ido Druckmann Solomon Dadia Ehud Rath Assaf Albagli Ben Efrima MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases BMC Musculoskeletal Disorders MRI-based navigation Fiducial markers Percutaneous CRA Desmoid Tumor 3D planning |
| title | MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases |
| title_full | MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases |
| title_fullStr | MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases |
| title_full_unstemmed | MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases |
| title_short | MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases |
| title_sort | mri based navigated cryosurgery of extra abdominal desmoid tumors using skin fiducial markers a case series of 15 cases |
| topic | MRI-based navigation Fiducial markers Percutaneous CRA Desmoid Tumor 3D planning |
| url | https://doi.org/10.1186/s12891-023-07074-6 |
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