Spinal cord ischemia after transcatheter artery chemoembolization for hepatocellular carcinoma: A case-report

International Journal of Surgery Case Reports, 2023 · DOI: https://doi.org/10.1016/j.ijscr.2023.108258 · Published: April 24, 2023

Spinal Cord Injury Oncology

Simple Explanation

Transarterial chemoembolization (TACE) is a common treatment for liver cancer, but it can sometimes lead to rare complications. This report describes a case where a patient undergoing TACE experienced spinal cord ischemia, a condition where the spinal cord doesn't receive enough blood. The patient, who had chronic hepatitis B and hepatocellular carcinoma, developed lower extremity weakness and sensory impairment after the second TACE procedure. MRI scans confirmed spinal cord ischemia. The doctors believe the ischemia was caused by the chemoembolization materials traveling through unusual connections between arteries and blocking blood flow to the spinal cord. This case highlights the importance of carefully planning TACE procedures to minimize potential complications.

Study Duration

Not specified

Participants

One 78-year-old male patient

Evidence Level

Level 4, Case Report

Key Findings

1
A 78-year-old male with chronic hepatitis B and HCC developed acute paraplegia and sensory loss after a second TACE procedure.
2
MRI revealed increased intramedullary signal strength at the T1-T12 level, confirming spinal cord ischemia.
3
The spinal cord ischemia was likely caused by embolization materials traveling through collateral arteries, specifically between the right inferior phrenic artery and intercostal arteries.

Research Summary

This case report describes a rare complication of TACE, spinal cord ischemia, in a patient with HCC. The patient experienced paraplegia and sensory deficits following the procedure. The etiology is hypothesized to be related to the embolic material traveling through collateral pathways between the inferior phrenic and intercostal arteries, ultimately affecting the anterior spinal artery. The authors emphasize the need for a tailored therapeutic strategy, including careful vessel selection during TACE, to minimize the risk of such complications.

Practical Implications

Careful Vessel Selection

When performing TACE, clinicians should carefully select the vessels used for Lipiodol infusion to avoid embolization of spinal arteries.

Consideration of Shunts

The use of shunts should be considered in patients at high risk for collateral flow to protect the spinal cord during TACE.

Awareness of Collateral Pathways

Clinicians need to be aware of potential extrahepatic collateral blood flow to HCC, such as the inferior phrenic artery, and its connections to intercostal arteries.

Study Limitations

1
Single case report limits generalizability.
2
The exact mechanism of embolization through collateral pathways could not be directly visualized.
3
Long-term outcomes of the patient were not fully detailed.

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