title: Retrospective review of thoracic neural damage during lung ablation - what the interventional radiologist needs to know about neural thoracic anatomy.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) is associated with low neural morbidity compared with surgery, which commonly causes debilitating long-term pain. The purpose was to review the thoracic neural anatomy relevant to percutaneous RFA and to retrospectively review symptomatic nerve injury after lung RFA at our institution.
  
  
  METHODS
  We retrospectively examined all symptomatic nerve injuries occurring after computed tomography (CT)-guided RFA treatment of lung tumors for 462 patients/509 procedures/708 lesions treated at our large tertiary referral centre during 10 years.
  
  
  RESULTS
  Eight patients experienced neurological complications after heating during the RFA procedure. These complications occurred in the phrenic (n = 1), brachial (n = 3), left recurrent (n = 1), and intercostal nerves (n = 2) and the stellate ganglion (n = 1). Three were grade 2, four grade 3 and one grade 4 injuries (CTCAE v3).
  
  
  CONCLUSIONS
  Although rare, neurological complications can occur after RFA, and they can occasionally be severe. To prevent these complications, it is important for the interventional radiologist to be aware of the anatomy of nervous structures and to attempt to identify nerves on CT scans during the RFA procedure. Creating a pneumothorax can be useful to avoid nerve damage and related clinical complications.
authors.affiliation: Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France. j.palussiere@bordeaux.unicancer.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Palussière
authors.affiliation: Department of Radiology, Centre Hospitalier Pau, 4 boulevard Hauterive, 64046, Pau Cedex, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Canella
authors.affiliation: Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France.
authors.forename: François
authors.initials: F
authors.lastname: Cornelis
authors.affiliation: Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Catena
authors.affiliation: Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Descat
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux Cedex, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Brouste
authors.affiliation: Department of Radiology, CHU Haut Lévêque, Avenue de Magellan, 33604, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D003964:Diaphragm / Q000033:anatomy & histology / Q000294:innervation; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D059348:Peripheral Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D010525:Peripheral Nerves / Q000033:anatomy & histology*; D015641:Radiography, Interventional / Q000379:methods; D015642:Radiology, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013909:Thorax / Q000033:anatomy & histology / Q000294:innervation*; D014057:Tomography, X-Ray Computed / Q000379:methods