Paraplegia following transarterial chemoembolisation for hepatocellular carcinoma: a case report

Abstract

Background

Transarterial chemoembolisation (TACE) is considered standard treatment for intermediate-stage hepatocellular carcinoma (HCC). Although TACE is viewed as a safe and effective procedure, it may still present with various complications, including spinal cord injury, though very rarely.

Methods

A 74-year-old male was diagnosed with non-B, non-C HCC, segment 4, cT2N0M0, AJCC stage II, BCLC stage B. Angiography had shown a hypervascular tumour stain indicating that both T10 and T11 were tumour-feeding arteries, TACE then performed. After TACE, loss of sensation and motor functions involving the trunk below the umbilicus and both lower extremities were noted. The patient immediately underwent steroid pulse therapy. However, 100 days after TACE, the symptoms showed no improvement.

Discussion

Because of anatomy and neurological distribution, it is conceivable that the embolic materials originating from the TACE procedure might have led to an embolic event with a serious manifestation, although the blood supply of the spinal cord encompasses multiple anastomoses.

Conclusion

Spinal cord injury is an extremely rare but grave complication of TACE. Paraplegia may result from inadvertent embolisation of spinal branches arising from intercostal or lumbar collateral vessels. This case highlights the necessity of evaluating and choosing the vessels before starting TACE to achieve a good outcome.

Keywords:

• Gastroenterology
• hepatocellular carcinoma
• transarterial chemoembolisation
• paraplegia
• spinal cord infarction

Acknowledgements

The authors thank the patient for allowing them to share his case, and acknowledge the assistance of Chih-Wei Wang, MD, in the editing and submission of their manuscript.

Disclosure statement

The authors declare that they have no conflicts of interest.