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Peer-reviewedCC BYBMC anesthesiology

Tunnelled intrathecal catheter enabling repeated spinal anaesthesia in MR-Linac radiotherapy: a case report.

  • Hasan Huseyin Kilic1,2
  • Onur Bukagikiran3,4
4 affiliations
  1. 1Department of Anaesthesiology, Dogus University, Istanbul, Turkey. [email protected].
  2. 2Department of Anaesthesiology and Reanimation, Hisar Intercontinental Hospital, Istanbul, Turkey. [email protected].
  3. 3Department of Anaesthesiology, Dogus University, Istanbul, Turkey.
  4. 4Department of Anaesthesiology and Reanimation, Hisar Intercontinental Hospital, Istanbul, Turkey.
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Abstract

Background

Magnetic resonance-guided linear accelerators (MR-Linac) integrate magnetic resonance imaging (MRI) with radiotherapy delivery, enabling adaptive treatment. However, patient immobility is required for 60-90 min within a high-field magnet, making anaesthetic management challenging. Sedation may be inadequate in patients with opioid tolerance or obstructive sleep apnoea, while general anaesthesia (GA) poses significant risks due to airway and equipment limitations in the MR environment.Case presentation

We present a 78-year-old male with prostate cancer, severe chronic pain, opioid tolerance, and prior spinal instrumentation undergoing 28 MR-Linac sessions. Sedation attempts failed due to persistent involuntary leg movements and apnoea episodes. GA was deemed high-risk due to obesity, obstructive sleep apnoea, chronic opioid and alcohol use, and limited emergency access in the MR-Linac suite. Epidural anaesthesia was unfeasible due to adhesions from prior spinal surgery. A tunnelled intrathecal catheter was placed at the L3-L4 level, enabling daily intermittent spinal anaesthesia with 0.5% bupivacaine. All 28 fractions were completed uneventfully, without infection, neurological deficit, or catheter-related complications.Conclusion

Repeated spinal anaesthesia delivered through a tunnelled intrathecal catheter enabled successful completion of MR-Linac radiotherapy in this carefully selected patient after conventional sedation had failed. This case highlights an individualized management approach for a challenging clinical scenario.

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Cite

BibTeXRIS
BibTeX
@article{kilic2026tunnelled,
  title = {{Tunnelled intrathecal catheter enabling repeated spinal anaesthesia in MR-Linac radiotherapy: a case report.}},
  author = {Hasan Huseyin Kilic and Onur Bukagikiran},
  journal = {BMC anesthesiology},
  year = {2026},
  month = aug,
  doi = {10.1186/s12871-026-04108-z},
  url = {https://europepmc.org/article/MED/42972256},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Tunnelled intrathecal catheter enabling repeated spinal anaesthesia in MR-Linac radiotherapy: a case report.
AU  - Hasan Huseyin Kilic
AU  - Onur Bukagikiran
PY  - 2026
DA  - 2026/08/06
JO  - BMC anesthesiology
DO  - 10.1186/s12871-026-04108-z
UR  - https://europepmc.org/article/MED/42972256
AB  - Background  Magnetic resonance-guided linear accelerators (MR-Linac) integrate magnetic resonance imaging (MRI) with radiotherapy delivery, enabling adaptive treatment. However, patient immobility is required for 60-90 min within a high-field magnet, making anaesthetic management challenging. Sedation may be inadequate in patients with opioid tolerance or obstructive sleep apnoea, while general anaesthesia (GA) poses significant risks due to airway and equipment limitations in the MR environment.Case presentation  We present a 78-year-old male with prostate cancer, severe chronic pain, opioid tolerance, and prior spinal instrumentation undergoing 28 MR-Linac sessions. Sedation attempts failed due to persistent involuntary leg movements and apnoea episodes. GA was deemed high-risk due to obesity, obstructive sleep apnoea, chronic opioid and alcohol use, and limited emergency access in the MR-Linac suite. Epidural anaesthesia was unfeasible due to adhesions from prior spinal surgery. A tunnelled intrathecal catheter was placed at the L3-L4 level, enabling daily intermittent spinal anaesthesia with 0.5% bupivacaine. All 28 fractions were completed uneventfully, without infection, neurological deficit, or catheter-related complications.Conclusion  Repeated spinal anaesthesia delivered through a tunnelled intrathecal catheter enabled successful completion of MR-Linac radiotherapy in this carefully selected patient after conventional sedation had failed. This case highlights an individualized management approach for a challenging clinical scenario.
SN  - 1471-2253
ER  -