Thermal Damage of the Genitofemoral Nerve Due to Radiofrequency Ablation of Renal Cell Carcinoma: A Potentially Avoidable Complication
Andreas Boss1,2,
Stephan Clasen1,
Markus Kuczyk3,
Aristotelis Anastasiadis3,
Diethard Schmidt1,
Claus D. Claussen1,
Fritz Schick2 and
Philippe L. Pereira1
1 Department of Diagnostic Radiology, University Hospital of Tübingen,
Hoppe Seyler Strasse 3, Tübingen, Germany 72076.
2 Section on Experimental Radiology, University Hospital of Tübingen,
Tübingen, Germany 72076.
3 Department of Urology, University Hospital of Tübingen, Tübingen,
Germany 72076.
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Fig. 1A —63-year-old man presenting with 2.1 x 2.3 cm renal cell
carcinoma. T2-weighted fast spin-echo image at 0.2 T shows renal cell
carcinoma (arrow) close to major psoas muscle (arrowheads).
Patient placed in prone position.
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Fig. 1B —63-year-old man presenting with 2.1 x 2.3 cm renal cell
carcinoma. After first cycle of radiofrequency treatment (12 min), T2-weighted
imaging shows coagulation necrosis within tumor exhibiting signal loss
(white arrow) and edema in residual tumor tissue (black
arrowhead). Radiofrequency cluster applicator still situated within tumor
(black arrow). Psoas major muscle shows area of edema (white
arrowhead).
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Fig. 1C —63-year-old man presenting with 2.1 x 2.3 cm renal cell
carcinoma. After second ablation cycle, coagulation necrosis was induced in
psoas muscle (arrowhead) by heat conduction.
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Fig. 2 —Genitofemoral nerve derives from first and second lumbar
nerve carrying sensory and motor nerve fibers. Nerve (black line)
passes through major psoas muscle (light red band) to emerge on its
anterior surface and runs laterally downward to divide into genital and
femoral branches. Genital branch passes through inguinal canal and supplies
cremaster muscle and small area of overlying skin. Femoral branch supplies
skin over femoral triangle. Renal parenchyma is shown in dark red. In
described technique, applicator is used as lever to displace kidney from psoas
muscle using site of skin entry (black X) as center of rotation.
After torquing handle in medial direction, kidney moves laterally, enlarging
distance from muscle.
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Fig. 3A —66-year-old man presenting with 3.1 x 2.5 cm renal cell
carcinoma. T2-weighted transverse fast spin-echo image (acquisition time 4 min
50 sec) shows radiofrequency applicator (arrow) positioned in center
of renal tumor (black arrowhead) 4 cm from psoas muscle (white
arrowheads).
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Fig. 3B —66-year-old man presenting with 3.1 x 2.5 cm renal cell
carcinoma. Needle and kidney were moved away from psoas muscle using
radiofrequency applicator as lever to distance of 1.5 cm. Applicator position
was visualized with T2-weighted fast spin-echo imaging during breath-hold (18
sec).
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Fig. 3C —66-year-old man presenting with 3.1 x 2.5 cm renal cell
carcinoma. After radiofrequency ablation, T2-weighted imaging (acquisition
time 4 min 50 sec) shows coagulation necrosis of tumor tissue (black
arrowhead). In psoas muscle, edema (white arrowhead) was induced
that resolved completely within 12 hr.
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Copyright © 2005 by the American Roentgen Ray Society.
