Microwave Thermal Ablation

• Combined use of SpineJack and microwave ablation with CT and C-arm in the treatment of vertebral fractures in oncologic patients: a case- based technical note
• Stereotactic body radiation therapy and thermal ablation for treatment of patients with pulmonary metastases: a systematic literature review and meta-analysis
• The Landmark Series: Multimodal Management of Oligometastatic Sarcoma
• Stereotactic body radiation therapy for primary renal cell carcinoma: A review on behalf of the CC-AFU
• Unresectable Intermediate-Size (3-5 cm) Colorectal Liver Metastases: Stereotactic Ablative Body Radiotherapy Versus Microwave Ablation (COLLISION-XL): Protocol of a Phase II/III Multicentre Randomized Controlled Trial
• Stereotactic body radiation therapy and thermal ablation for treatment of NSCLC: A systematic literature review and meta-analysis
• Nonsurgical Therapy for Early-Stage Lung Cancer
• Introduction to novel developments in radio-imaging and radiotherapy

Microwave thermal ablation (MWA) is a minimally invasive technique that delivers electromagnetic energy in the microwave spectrum to destroy pathological tissues via coagulative necrosis. In neurosurgery, MWA is emerging as a treatment option for deep-seated or inoperable tumors, both intracranial and spinal.

• Deep-seated gliomas
• Brain metastases
• Spinal metastases
• Experimental use in functional neurosurgery (e.g., epilepsy)

• 'Device:' Microwave generator (2.45 GHz), cooled antenna
• 'Guidance:' Frameless stereotaxy or intraoperative neuronavigation
• 'Ablation time:' Typically 2–10 minutes
• 'Temperature:' 60–100°C at target site
• 'Monitoring:' Intraoperative thermal mapping or post-ablation MRI

• Faster and deeper heating than RFA (radiofrequency ablation)
• Less susceptibility to local tissue impedance
• Capable of larger and more uniform ablation zones

• Thermal spread to adjacent eloquent cortex or vessels
• Heat sink effect from nearby vasculature
• Risk of edema or delayed necrosis

A technical report highlights the combined treatment of bone metastases using CT imaging and C-arm fluoroscopy to guide microwave thermal ablation and the SpineJack system. The integration of these imaging techniques was crucial for achieving local tumor control and restoring vertebral stability in cases of pathological fractures associated with metastatic disease. CT imaging ensured accurate tumor volume measurement and ablation, safe needle placement, and secure positioning of protective devices. C-arm fluoroscopy provided real-time guidance for the correct positioning of the SpineJack implants, monitoring their expansion, and ensuring controlled cement application. Although these techniques have been increasingly utilized, this is the first detailed report to focus on their combined use in treating pathological fractures within a metastatic setting ¹⁾.

This case-based technical note is a valuable contribution to the growing field of minimally invasive, image-guided oncologic spine interventions. The combination of microwave ablation and the SpineJack system under dual imaging guidance offers a promising approach to managing metastatic vertebral fractures. However, broader validation through prospective studies, inclusion of clinical outcomes, and cost–benefit analyses are needed before widespread adoption.

Microwave thermal ablation represents a promising adjunct in the neurosurgical treatment arsenal, particularly for tumors in eloquent or deep brain locations where resection may carry high risk.