title: Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation.
abstract: OBJECTIVE
  We present our experience of utilizing peripheral nerve electrostimulation as a complementary monitoring technique during percutaneous thermal ablation procedures; and we highlight its utility and feasibility in the prevention of iatrogenic neurologic thermal injury.
  
  
  METHODS
  Peripheral motor nerve electrostimulation was performed in 12 patients undergoing percutaneous image-guided thermal ablations of spinal/pelvic lesions in close proximity to the spinal cord and nerve roots. Electrostimulation was used in addition to existing insulation (active warming/cooling with hydrodissection, passive insulation with CO2 insufflation) and temperature monitoring (thermocouples) techniques. Impending neurologic deficit was defined as a visual reduction of muscle response or need for a stronger electric current to evoke muscle contraction, compared with baseline.
  
  
  RESULTS
  Significant reduction of the muscle response to electrostimulation was observed in three patients during the ablation, necessitating temporary interruption, followed by injection of warm/cool saline. This resulted in complete recovery of the muscle response in two cases, while for the third patient the response did not improve and the procedure was terminated. No patient experienced postoperative motor deficit.
  
  
  CONCLUSIONS
  Peripheral motor nerve electrostimulation is a simple, easily accessible technique allowing early detection of impending neurologic injury during percutaneous image-guided thermal ablation. It complements existing monitoring techniques and provides a functional assessment along the whole length of the nerve.
authors.affiliation: University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France. gtsoumakidou@yahoo.com.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tsoumakidou
authors.affiliation: University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Garnon
authors.affiliation: University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France.
authors.forename: Nitin
authors.initials: N
authors.lastname: Ramamurthy
authors.affiliation: University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Buy
authors.affiliation: University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gangi
mesh_terms: D001831:Body Temperature / Q000502:physiology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods*; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D009044:Motor Cortex / Q000502:physiology; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D010525:Peripheral Nerves / Q000502:physiology*; D015642:Radiology, Interventional / Q000379:methods; D012965:Sodium Chloride / Q000008:administration & dosage; D013127:Spinal Nerves / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride