Anil Nicholas Kurup MD, Presenter: Nothing to Disclose

Jonathan Michael Morris MD, Abstract Co-Author: Nothing to Disclose

Thomas Duncan Atwell MD, Abstract Co-Author: Nothing to Disclose

Grant D. Schmit MD, Abstract Co-Author: Nothing to Disclose

Peter Rose MD, Abstract Co-Author: Nothing to Disclose

Matthew Raymond Callstrom MD, PhD, Abstract Co-Author: Research Grant, Thermedical, Inc Research Grant, General Electric Company Research Grant, Siemens AG Research Grant, Galil Medical Ltd

Percutaneous osteoplasty has been described as a method to alleviate pain and to provide structural support for osteolytic tumors at risk of fracture. However, cement extravasation outside the bone may occur with severe bony erosion or destruction, We describe a new technique using kyphoplasty balloons to promote targeted delivery of cement into the pathologic lesion.

After IRB approval, the radiology departmental ablation database was searched for cases of combined cryoablation and balloon-assisted osteoplasty performed to treat tumors in the periacetabular region between March 2013 and February 2014. Procedures were performed under general anesthesia with CT guidance and neurophysiologic monitoring. Balloon-assisted osteoplasty was performed in the same session as or the day following cryoablation. One or more 20-mm kyphoplasty balloons were inflated in the ablation defect prior to cement instillation.  Cement was then injected in typical fashion under CT-fluoroscopic guidance.  Images were reviewed for cement leakage outside of the tumor cavity.

14 combined procedures were performed in 14 patients (9M:5F) with median age of 66 years (range, 43-81). 7 cases were performed primarily for palliation of pain, while 7 were performed solely for risk of impending fracture. 10 (71%) patients had metastases treated, and 4 (39%) had primary bone tumors (myeloma, fibrous dysplasia). Periacetabular tumors were located superiorly in 5, posterosuperiorly in 3, posteriorly in 1, anteriorly in 3, and anteromedially in 2 patients. Median tumor size was 4.0 cm (range, 2.9-7.6), and median estimated tumor volume was 24 mL (range, 9-148). Mean number of balloons used was 2 (range, 1-4). Median cement volume instilled in the ablation cavities was 14 mL (range, 8-35 mL). Median percentage tumor fill was 59% (range, 24-96%). Minimal extravasation (less than 1 mL) was identified in 4 cases.

Balloon-assisted periacetabular osteoplasty following percutaneous cryoablation is feasible, may minimize the risk of cement extravasation, and may improve the degree of filling of the osteolytic defect.

Osteolytic tumors in the periacetabular region are frequently painful and at risk of fracture. Use of kyphoplasty balloons to create space for cement filling following cryoablation may minimize the risks of this procedure and allow safe consolidation of these challenging tumors.

Kurup, A, Morris, J, Atwell, T, Schmit, G, Rose, P, Callstrom, M, Balloon-assisted Osteoplasty of Periacetabular Tumors Following Percutaneous Cryoablation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016574.html