Direct ethanol injection for skull metastasis from hepatocellular carcinoma. The techniques and consequences of a therapeutic trial

The frequency of skull metastasis from hepatocellular carcinoma (HCC) is in creasing together with the recent progress in the management of the primary lesion. Cases are often complicated with poor general conditions or metast asis to the other organs, and not readily indicated for surgery. A direct i njection of ethanol to the lesion could be one of the therapeutic options t o cope with this complicated situation. To evaluate the feasibility of this technique, we planned a therapeutic trial in a patient with HCC associated with lumbar and skull metastasis, the latter metastasis repeated twice dur ing the past one year. A total of 10 mi of ethanol was injected into the sk ull metastasis percutaneously under ultrasound (US) guidance. US guidance w as very useful in determining the sites of injections and the distribution of ethanol as well as monitoring the blood flow within the tumor vessels. T he patient transiently complained of local pain at the injection sites, but there were no other adverse effects. Four days after the injection, the le sion was resected by surgery, which confirmed the pathologic diagnosis as w ell as the nearly-total necrosis of the tumor. This technique is simple, sa fe and repeatable with low cost The technical details and the histologic ef fects are described.