Image-guided interventions continue to expand options for patients who for years have faced limited opportunities.
Monday’s practice development session “Emerging IR Therapies” highlighted case studies of specialized or emerging procedural techniques and discussed the outcomes of patients who have received them and how attendees can introduce these therapies into their practice.
Session Co-chair Christos Georgiades, MD, PhD, FSIR, FCIRSE, explained CT-guided chemical sympatholysis, a therapy developed for patients with hyperhidrosis that he and his colleagues at Johns Hopkins University and in Europe developed. The outpatient procedure involves percutaneously inserting needles at the site of affected nerves and ablating the nerves after an initial injection of lidocaine.
“It’s amazing. If you inject one side with lidocaine, one hand will stop and be dry immediately,” Dr. Georgiades said. “It’s not a hormonal problem; this is a neurological problem. The reaction is immediate.”
Dr. Georgiades updated results he previously presented for this procedure with a larger group of patients and involving additional sites of excessive sweating, including the face, head and chest, as well as the hands and axilla. Between 50 and 60 percent of the patients treated had complete resolution of hyperhidrosis during the 1-year follow-up, and some have also had improvements in co-morbidities such as cardiac arrhythmia.
First-line treatments for hyperhidrosis, including antiperspirants and anticholinergic medications, offer only partial relief and eventually lose effectiveness. Patients often then elect to have bilateral chest surgery to ligate the nerves. Although surgery has long-term efficacy at the original site of sweating in about 80 percent of cases, patients nearly always develop compensatory hyperhidrosis in other parts of the body. CT-guided, chemical sympatholysis, along with being a safer procedure than surgery, according to Dr. Georgiades, is only associated with compensatory hyperhidrosis in about 15 percent of patients. This new procedure has also been used to treat patients who developed compensatory hyperhidrosis after surgery.
Douglas B. Yim, MD, FSIR, Johns Hopkins Hospital, detailed a procedure that may offer an alternative to traditional endoscopic lumbar microdiscectomy. Because of ever-shrinking technology, the procedure requires making only a 5-millimeter hole at the top of the buttocks to access the sacral hiatus. Using X-ray guidance, a very small scope and laser is introduced through the naturally occurring hole to enter the ventral epidural space at the site of protruding diseased disc tissue that the laser then removes. The incision is so small that it can be closed with a single bandage. In contrast, even minimally invasive surgery requires making at least a 2-centimeter incision.
“This is a very natural evolution for the interventional radiologist,” he said. “It kind of fits in with what we’ve always been doing. It’s just a matter of learning it.”
Dr. Yim presented early data from his colleagues in Korea on the procedure, including MRI data from patients pre and post procedure and patient-reported outcomes after 12 months, such as pain and satisfaction. Although the procedure is not currently performed in the United States, it was recently granted FDA approval. He believes it could even become part of the growing use of image-guided interventions in the field of orthopedics.