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Filippiadis D, Petsatodis E, Charalampopoulos G, Giannakis A, Chlorogiannis DD, Velonakis G, Cornelis F. Benign Soft Tissue Lesions Responsible for Pain: When and How Should the IR Intervene. Cardiovasc Intervent Radiol 2025:10.1007/s00270-024-03940-5. [PMID: 39789262 DOI: 10.1007/s00270-024-03940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 12/08/2024] [Indexed: 01/12/2025]
Abstract
In most of the cases Interventional Radiology techniques and therapies are proposed for the management of symptomatic soft tissue benign tumors responsible for pain and/or compression symptoms aiming to offer a curative intent by means of tumor necrosis with subsequent symptoms' management and improvement of life quality. The ablative therapies include chemical, thermal and non-thermal approaches while, trans-arterial (chemo)embolization also has a distinct role. Adjunct ancillary techniques should be performed whenever necessary to increase efficacy and safety and avoid or reduce complications. The purpose of the current review is to identify the basis for treating soft tissue benign tumors with Interventional Radiology therapies, to offer a detailed review of them, to explain the expected outcomes and describe techniques for avoiding complications. Furthermore, a reflection upon future directions will be suggested.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Department of Radiology, School of Medicine, 'Attikon' University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Haidari/Athens, Greece.
| | - Evangelos Petsatodis
- Interventional Radiology Department, G. Papanikolaou General Hospital Thessaloniki, Polikleitou Regou 15, 54646, Thessaloniki, Greece
| | - Georgios Charalampopoulos
- Second Department of Radiology, School of Medicine, 'Attikon' University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Haidari/Athens, Greece
| | - Athanasios Giannakis
- Second Department of Radiology, School of Medicine, 'Attikon' University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Haidari/Athens, Greece
| | | | - Georgios Velonakis
- Second Department of Radiology, School of Medicine, 'Attikon' University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Haidari/Athens, Greece
| | - Francois Cornelis
- Neuro Vascular Interventional Radiology Program, Department of Radiology, Memorial Sloan Kettering Cancer Center (MSK), New York, NY, 10065, USA
- Weill Cornell Medical College, New York, NY, 10065, USA
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2
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Uka M, Matsui Y, Iguchi T, Matsushita T, Tomita K, Umakoshi N, Kawabata T, Yamada M, Hiraki T. Magnetic Resonance Imaging Guidance for Percutaneous Needle Intervention. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2024; 9:92-98. [PMID: 39559804 PMCID: PMC11570213 DOI: 10.22575/interventionalradiology.2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 11/20/2024]
Abstract
Magnetic resonance imaging (MRI) is one of the guiding modalities used for percutaneous needle insertion during interventional procedures. MRI guidance has several advantages, including multiplanar imaging capability, superior soft tissue contrast resolution, and the absence of ionizing radiation. When performing MRI-guided procedures, it is important to understand the suitable MRI systems, instruments, and imaging sequences for intervention. Furthermore, needle artifact characteristics must be fully understood to ensure safe and accurate needle insertion. In this article, we present the fundamental knowledge as regards the use of MRI guidance for percutaneous needle insertion and review its usefulness in representative interventional procedures, such as biopsy and tumor ablation.
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Affiliation(s)
- Mayu Uka
- Department of Radiology, Okayama University Hospital, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Japan
| | - Toshi Matsushita
- Division of Radiological Technology, Okayama University Hospital, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Japan
| | | | | | | | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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3
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Moulin B, Angelopoulos G, Sarrazin JL, Romano S, Vignaux O, Guenoun T, Di Primio M, Hakime A. Safety and Efficacy of Percutaneous Morton Neuroma Cryoneurolysis Under Ultrasound Guidance. Cardiovasc Intervent Radiol 2024; 47:795-800. [PMID: 38438685 DOI: 10.1007/s00270-024-03669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/20/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE To assess the technical success, safety and early efficacy of Morton neuroma (MN) cryoneurolysis. MATERIALS AND METHODS Retrospective review of 54 consecutive patients with MN treated with cryoneurolysis after failure of conservative treatment, from September 2022 to June 2023. Outcomes measurements included technical success (defined a successful ultrasound-guided placement of the cryoprobe), procedural safety according to Cirse classification and change in 6 months post-procedure by pain numeric rating scale (pNRS). RESULTS A total of 59 MN were treated during 55 procedures. Mean procedure duration was 47 min, all patients were discharged 2 h after the intervention. Technical success was 98.1%. No Cirse grade 3, 4 or 5 complication was reported. Three grade 2 complication occurred, including two chilblain-type lesions and one bone insufficiency fracture. At 6 months post-procedure, pNRS score was significantly decreased (2.7 ± 2.2 vs 7.1 ± 1.1) (p < 0.0001), with a mean score decrease of 4.1points. Thirty-two patients (60.4%) reported a complete pain relief, 15 (28.3%) a partial pain relief and 6 (11.3%) no pain relief, or increased pain. CONCLUSION Cryoneurolysis seems to be safe for the treatment of Morton neuroma. Six-month pain relief is promising and needs to be confirmed at long term.
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Affiliation(s)
- Benjamin Moulin
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France.
| | - Giorgio Angelopoulos
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
| | - Jean Luc Sarrazin
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
| | - Stephane Romano
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
| | - Olivier Vignaux
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
| | - Thierry Guenoun
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
| | - Massimiliano Di Primio
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
| | - Antoine Hakime
- From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France
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Kaufman C, Jahangiri Y, Otto B. Comparative Effectiveness of Cryoablation with Steroid and Lidocaine Versus Steroid and Lidocaine Alone for Treatment of Morton Neuroma: Protocol for a Randomized Controlled Trial. J Vasc Interv Radiol 2024; 35:767-769. [PMID: 38272113 DOI: 10.1016/j.jvir.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/27/2024] Open
Affiliation(s)
- Claire Kaufman
- Dotter Interventional Institute, Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon.
| | - Younes Jahangiri
- Division of Interventional Radiology, Corewell Health West Michigan, Grand Rapids, Michigan
| | - Bettricia Otto
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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Winkelmann MT, Kübler J, Hoffmann R. Magnetic Resonance-guided Procedures: Consensus on Rationale, Techniques, and Outcomes. Tech Vasc Interv Radiol 2023; 26:100914. [PMID: 38071023 DOI: 10.1016/j.tvir.2023.100914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Magnetic resonance (MR) image guidance has demonstrated significant potential in the field of interventional radiology in several applications. This article covers the main points of MR-guided hepatic tumor ablation as a representative of MR-guided procedures. Patient selection and appropriate equipment utilization are essential for successful MR-guided tumor ablation. Intra-procedural planning imaging enables the visualization of the tumor and surrounding anatomical structures in most cases without the application of a contrast agent, ensuring optimal planning of the applicator tract. MRI enables real-time, multiplanar imaging, thus simultaneous observation of the applicator and target tumor is possible during targeting with adaptable slice angulations in case of challenging tumor positions. Typical ablation zone appearance during therapy monitoring with MRI enables safe assessment of the therapy result, resulting in a high primary efficacy rate. Recent advancements in ablation probes have shortened treatment times, while technical strategies address applicator visibility issues. MR-imaging immediately after the procedure is used to rule out complications and to assess technical success. Especially in smaller neoplasms, MRI-guided liver ablation demonstrates positive outcomes in terms of technical success rates, as well as promising survival and recurrence rates. Additionally, percutaneous biopsy under MR guidance offers an alternative to classic guidance modalities, providing high soft tissue contrast and thereby increasing the reliability of lesion detection, particularly in cases involving smaller lesions. Despite these advantages, the use of MR guidance in clinical routine is still limited to few indications and centers, due to by high costs, extended duration, and the need for specialized expertise. In conclusion, MRI-guided interventions could benefit from ongoing advancements in hardware, software, and devices. Such progress has the potential to expand diagnostic and treatment options in the field of interventional radiology.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jens Kübler
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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6
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Burke CJ, Walter WR, Adler RS. Interventional Imaging Techniques as Alternative to Surgery of the Foot and Ankle. Semin Musculoskelet Radiol 2022; 26:744-754. [PMID: 36791742 DOI: 10.1055/s-0042-1760120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A variety of foot and ankle pathologies can impair patient's daily activities, ultimately requiring surgical management. However, with improvements in image-guided intervention, the joints, soft tissues, and osseous structures may be accessible using various percutaneous techniques as a potential alternative therapeutic tool, avoiding the need for surgery with its associated risks and morbidity. This article discusses the potential range of image-guided interventional treatments. Injections, aspiration, biopsies, cryoablation, and radiofrequency ablation are described. Newer novel treatments are also covered. Finally, the common pathologies of Morton's neuroma, Achilles tendinopathy, and plantar fasciitis are addressed.
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Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Orthopedic Center, Center for Musculoskeletal Care, New York, New York
| | - William R Walter
- Department of Radiology, NYU Langone Orthopedic Center, Center for Musculoskeletal Care, New York, New York
| | - Ronald S Adler
- Department of Radiology, NYU Langone Orthopedic Center, Center for Musculoskeletal Care, New York, New York
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7
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Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res 2022; 15:925-937. [PMID: 35411187 PMCID: PMC8994628 DOI: 10.2147/jpr.s355096] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | | | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | | | - Jarod John
- Argires Marotti Neurosurgical Associates, Lancaster, PA, USA
| | | | - Tony Vanetesse
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
| | | | - Philip Kim
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
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8
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Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, Aparisi Gómez MP, Aringhieri G, Bazzocchi A, Beggs I, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gitto S, Grainger AJ, Greenwood S, Gupta H, Isaac A, Ivanoski S, Khanna M, Klauser A, Mansour R, Martin S, Mascarenhas V, Mauri G, McCarthy C, McKean D, McNally E, Melaki K, Messina C, Mirón Mombiela R, Moutinho R, Olchowy C, Orlandi D, Prada González R, Prakash M, Posadzy M, Rutkauskas S, Snoj Ž, Tagliafico AS, Talaska A, Tomas X, Vasilevska Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Obradov M. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle. Eur Radiol 2022; 32:1384-1394. [PMID: 34432122 PMCID: PMC8794903 DOI: 10.1007/s00330-021-08125-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. METHODS We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. RESULTS A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. CONCLUSION According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively. KEY POINTS • The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.
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Affiliation(s)
- Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, the Netherlands
| | - Domenico Albano
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | | | - Georgina Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK
- University of Oxford, Oxford, UK
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Vito Chianca
- Ospedale Evangelico Betania, Napoli, Italy
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
| | - Angelo Corazza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Danoob Dalili
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, Italy
| | | | | | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Haidari, Athens, Greece
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Amanda Isaac
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospitals, London, UK
| | - Slavcho Ivanoski
- Department of Radiology, Special Hospital for Orthopedic Surgery and Traumatology, St. Erazmo -, Ohrid, North Macedonia
- Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | | | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Ramy Mansour
- Oxford Musculoskeletal Radiology, Oxford University Hospitals, Oxford, UK
| | | | - Vasco Mascarenhas
- Hospital da Luz, Musculoskeletal Imaging Unit, Lisbon, Portugal
- AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal
| | - Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | | | - David McKean
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Kalliopi Melaki
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carmelo Messina
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | | | - Ricardo Moutinho
- Hospital da Luz, Musculoskeletal Imaging Unit, Lisbon, Portugal
- Hospital de Loulé, Loulé, Portugal
| | - Cyprian Olchowy
- Department of Oral Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Davide Orlandi
- Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
| | | | - Mahesh Prakash
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | | | - Saulius Rutkauskas
- Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Žiga Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alberto Stefano Tagliafico
- Department of Health Sciences, University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Xavier Tomas
- Radiology Dpt. MSK Unit. Hospital Clinic (CDIC), University of Barcelona (UB), Barcelona, Spain
| | | | - Jelena Vucetic
- Radiology Department, Hospital ICOT Ciudad de Telde, Las Palmas, Spain
| | | | | | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Varelli Institute, Naples, Italy
| | - Marina Obradov
- Department of Radiology, Sint Maartenskliniek, Nijmegen, The Netherlands
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9
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von Falck C, Orgel M, Wacker F, Aschoff HH, Krettek C, Ringe KI. Icing the Pain-Ultrasound-Guided Cryoablation of Symptomatic Post-Amputation Stump Neuroma. Cardiovasc Intervent Radiol 2021; 45:223-227. [PMID: 34820693 PMCID: PMC8807464 DOI: 10.1007/s00270-021-02998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Abstract
Purpose To assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation. Material and Methods Seven patients (3 females, 4 males; mean age 42 years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant. Results Nine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27 months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100). Conclusion In our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results. Level of Evidence Level 2, Observational study with dramatic effect
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Affiliation(s)
- C von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - M Orgel
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - H H Aschoff
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - C Krettek
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - K I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
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10
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Ultrasound-guided Injection Treatments versus Surgical Neurectomy for Morton Neuroma: A Cost-effectiveness Analysis. AJR Am J Roentgenol 2021; 218:234-240. [PMID: 34523955 DOI: 10.2214/ajr.21.26419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. Objective: The aim of this study was to determine the most cost-effective treatment pathway for symptomatic Morton neuromas that have failed conservative management. Methods: An incremental cost-utility analysis was performed comparing a direct to surgical neurectomy strategy with three injection selective strategies in which one or more ultrasound-guided injection therapies was tried first prior to surgery for non-responders. The three injection selective strategies included: (1) steroid selective (2) alcohol selective, and (3) steroid/alcohol selective in which both steroid injections and alcohol sclerosing injections were trialed successively prior to surgical neurectomy. The direct to surgery approach was compared with the three different injection selective strategies, and with a no-treatment strategy, in a decision-analytic model for a hypothetical group of patients with symptomatic Morton neuromas that had failed conservative management. Model parameters including treatment costs, effectiveness, complication rates, and health utility states were estimated from the literature, reimbursement databases, and expert opinion. The outcome was cost per quality adjusted life year (QALY) with a time horizon of three years. A societal cost perspective was adopted with a willingness to pay threshold of $100,000 per QALY. Sensitivity analyses for key model parameters were performed. Results: For the base input values, the steroid/alcohol selective strategy was dominant and yielded an incremental cost-effectiveness ratio of $4401/QALY compared to no treatment. The probabilistic sensitivity analysis supported this strategy in 74% of 10,000 simulated trials. Results were robust with low sensitivity to most input parameters. However, when the probability of successful alcohol injection treatment dropped below 40%, the steroid selective strategy became most cost-effective. Conclusion: A trial of ultrasound-guided injection therapies for Morton neuroma is a cost-effective strategy compared to proceeding directly to surgical neurectomy. Clinical Impact: Ultrasound-guided injection therapies are indicated as a first line treatment for patients with symptomatic Morton neuromas that have failed conservative management.
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Dalili D, Ahlawat S, Rashidi A, Belzberg AJ, Fritz J. Cryoanalgesia of the anterior femoral cutaneous nerve (AFCN) for the treatment of neuropathy-mediated anterior thigh pain: anatomy and technical description. Skeletal Radiol 2021; 50:1227-1236. [PMID: 33094409 DOI: 10.1007/s00256-020-03650-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe and illustrate the magnetic resonance imaging (MRI) anatomy of the anterior femoral cutaneous nerve (AFCN) and a new technique for cryoanalgesia of the AFCN for long-term analgesic treatment of recalcitrant AFCN-mediated neuropathic pain. MATERIALS AND METHODS Using a procedural high-resolution MRI technique, we describe the MRI anatomy of the AFCN. Three patients (mean age, 48 years; range, 41-67 years) with selective nerve block-verified recalcitrant AFCN-mediated anterior thigh pain were enrolled to undergo cryoanalgesia of the AFCN. Procedures were performed under MRI guidance using clinical wide-bore MR imaging systems and commercially available cryoablation system with MR-conditional probes. Outcome variables included technical success, clinical effectiveness including symptom relief measured on an 11-point visual analog scale, frequency of complications, and procedure time. RESULTS Procedural MRI allowed to successfully demonstrate the course of the AFCN, accurate cryoprobe placement, and monitoring of the ice ball, which resulted in technically successful iceball growth around the AFCN in all cases. All procedures were clinically effective, with median pain intensity decreasing from 8 (7-9) before the procedure to 1 (0-2) after the procedure. The cryoanalgesia effect persisted during a 12-month follow-up period in all three patients. No major complications occurred. The average total procedure time was 98 min (range, 85-125 min). CONCLUSION We describe the MRI anatomy of the AFCN and a new technique for cryoanalgesia of the AFCN using MRI guidance, which permits identification of the AFCN, selective targeting, and iceball monitoring to achieve long-term AFCN-mediated neuropathic pain relief.
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Affiliation(s)
- Danoob Dalili
- Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.,Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivani Ahlawat
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Rashidi
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan J Belzberg
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA.
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Finneran Iv JJ, Ilfeld BM. Percutaneous cryoneurolysis for acute pain management: current status and future prospects. Expert Rev Med Devices 2021; 18:533-543. [PMID: 33961531 DOI: 10.1080/17434440.2021.1927705] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Conventional nerve blocks utilize local anesthetic drugs to provide pain relief for hours or days following surgery or trauma. However, postoperative and trauma pain can last weeks or months. Ultrasound-guided percutaneous cryoneurolysis is an anesthetic modality that offers substantially longer pain relief compared to local anesthetic-based nerve blocks.Areas covered: In this review, we discuss the history, mechanism of action, and use of ultrasound-guided percutaneous cryoneurolysis by anesthesiologists in the setting of acute pain management.Expert opinion: Ultrasound-guided percutaneous cryoneurolysis offers the potential to provide weeks or months of pain relief following surgery or trauma. Compared to continuous local anesthetic-based peripheral nerve blocks, currently the gold standard for providing long duration postoperative analgesia, cryoneurolysis has benefits that include: 1) longer duration measured in weeks or months rather than days; 2) no external reservoir of local anesthetic to be carried by the patient; 3) no risk of infection; and 4) no risk of catheter dislodgement. However, cryoneurolysis can induce a prolonged motor block in addition to the sensory block, decreasing the appropriate indications to those in which potential sensory and motor deficits are acceptable. Additionally, cryoneurolysis of multiple nerves can have a substantial time requirement relative to conventional nerve blocks.
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Affiliation(s)
- John J Finneran Iv
- Outcomes Research Consortium, Cleveland, Ohio, USA.,Department of Anesthesiology, University of California San Diego, San Diego, California, USA
| | - Brian M Ilfeld
- Outcomes Research Consortium, Cleveland, Ohio, USA.,Department of Anesthesiology, University of California San Diego, San Diego, California, USA
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Incidence, Diagnosis, and Management of Neuromas Following Radiofrequency Ablation Treatment: a Narrative Review. Curr Pain Headache Rep 2021; 25:45. [PMID: 33961177 DOI: 10.1007/s11916-021-00964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the epidemiology of neuroma formation as a complication following radiofrequency ablation for chronic pain conditions as well as reviewing the diagnosis and management of neuromas. DESIGN Evidence-based narrative review and critical appraisal of literature. RESULTS A comprehensive review of the literature generated one case report describing neuroma formation following lumbar facet medial branch radiofrequency denervation. The rare incidence may be explained by neuroma pathophysiology and peripheral nerve injury produced by radiofrequency ablation, in combination with its asymptomatic nature. Diagnosis of neuromas is predominantly confirmed by clinical history and physical exam with potential for nerve blocks or imaging. Ultrasound has been suggested as a primary imaging modality with magnetic resonance imaging as a secondary option. Neuroma management ranges from conservative therapy to surgery with varying success rates. CONCLUSIONS Neuroma formation following radiofrequency ablation procedures is exceedingly rare and could be a hypothetical concern in clinical practice. However, the true incidence may be inaccurate given the asymptomatic nature of neuromas.
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14
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Nygaard NPB, Koch-Jensen C, Vægter HB, Wedderkopp N, Blichfeldt-Eckhardt M, Gram B. Cryoneurolysis for the management of chronic pain in patients with knee osteoarthritis; a double-blinded randomized controlled sham trial. BMC Musculoskelet Disord 2021; 22:228. [PMID: 33637085 PMCID: PMC7913284 DOI: 10.1186/s12891-021-04102-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
Objective Pain is the principal symptom in knee osteoarthritis (OA). Current non-operative treatment options have only moderate effects and often patients experience persistent pain or side-effects. Novel advances in the field of cryoneurolysis applies low temperatures to disrupt nerve signaling at the painful area, providing pain relief. The primary aim of this randomized controlled trial (RCT) is to investigate if cryoneurolysis is superior to sham at decreasing pain intensity 2 weeks after the intervention in patients with knee OA. Secondary aims are to explore effects on pain, quality of life and functional performance over 24 months. Methods This two-arm, parallel-group RCT, approved by the Regional Ethics Committee, will randomly allocate patients (n = 94) to a cryoneurolysis intervention group + standardized education and exercise (CRYO) or a sham group + standardized education and exercise (SHAM) (1:1 ratio). Both groups will be assessed at baseline, 2 weeks post intervention, post education and exercise and at 6, 12 and 24 months after cryoneurolysis. The primary outcome is the NRS knee pain intensity score assessed 2 weeks post the intervention. Secondary outcome measures include functional performance (chair-stand test, 40 m walk, stair test and maximum voluntary contraction of the knee), patient reported outcomes (quality of life (EQ5D), Knee and osteoarthritis outcome scores (KOOS), among others), use of analgesics, and adverse events over 24 months. Impact statement Cryoneurolysis could potentially provide an effective, safe and non-pharmacological therapeutic option to treat pain in OA patients. The potential benefits include increased functional capacity and quality of life as a result of significant pain relief and improved benefits of physical exercise. Trial registration Clinicaltrials.gov, NCT03774121, registered 3 March 2018, http://www.clinicaltrials.gov
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Affiliation(s)
- Niels-Peter Brøchner Nygaard
- Research Unit of Health Science, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Carsten Koch-Jensen
- Department of Neurology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Henrik Bjarke Vægter
- Pain Research Group, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Wedderkopp
- Department of Orthopedics, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Morten Blichfeldt-Eckhardt
- Pain Research Group, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bibi Gram
- Research Unit of Health Science, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Treating Morton's neuroma by injection, neurolysis, or neurectomy: a systematic review and meta-analysis of pain and satisfaction outcomes. Acta Neurochir (Wien) 2021; 163:531-543. [PMID: 32056015 DOI: 10.1007/s00701-020-04241-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton's neuroma with respect to these outcomes. METHODS Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions. RESULTS A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton's neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23-64%) was significantly lower than neurolysis (68%; 95% CI, 51-84%) and neurectomy (74%; 95% CI, 66-82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21-50%) was significantly lower than neurolysis (63%; 95% CI, 50-74%) and neurectomy (57%; 95% CI, 47-67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9-23%) versus neurolysis (2%; 95% CI, 0-4%) or neurectomy (5%; 95% CI, 3-7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30). CONCLUSIONS Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton's neuroma should incorporate these findings to better form and meet the expectations of patients.
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16
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Filippiadis D, Efthymiou E, Tsochatzis A, Kelekis A, Prologo JD. Percutaneous cryoanalgesia for pain palliation: Current status and future trends. Diagn Interv Imaging 2020; 102:273-278. [PMID: 33281081 DOI: 10.1016/j.diii.2020.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
Cryoanalgesia, otherwise termed cryoneurolysis, refers to application of extreme cold upon peripheral nerves for palliation of pain associated to nerve lesions or biomechanical syndromes of neoplastic and non-neoplastic substrate. Application of cryoanalgesia initiates a cascade of pathophysiologic events interrupting nerve conduction of painful stimuli without irreversible nerve damage. Cryoanalgesia is considered a safe procedure with minimal risk of complications when performed with percutaneous approaches under imaging guidance. In the era of an opioid overdose crisis, cryoanalgesia can be proposed as an alternative aiming at controlling pain and improving life quality. Imaging guidance has substituted open surgical and nerve stimulation approaches in nerve identification, significantly contributing to the minimally invasive character of percutaneous approaches. Ultrasound or computed tomography can serve as low cost, ideal guiding techniques due to their abilities for precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to become familiar with the most common imaging guided percutaneous cryoanalgesia indications, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Efthymiou
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Tsochatzis
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Kelekis
- Second Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - J D Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364, Clifton road NE, 30322 Atlanta, GA, USA
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17
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Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain. Anesthesiology 2020; 133:1127-1149. [PMID: 32898231 DOI: 10.1097/aln.0000000000003532] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.
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Abstract
The application of advanced imaging guidance and the interventional radiology skill set has expanded the breadth of nerve and nerve plexus targets in the body for potential cryoneurolysis. Advancement of the basic science supporting cryoneurolysis has further solidified proceduralists' confidence and ability to select and manage patients clinically. As these procedures continue to evolve, a structured approach to the wide variety of indications is necessary.
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Affiliation(s)
- J David Prologo
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Faramarz Edalat
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mohamad Moussa
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
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Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. J Foot Ankle Res 2019; 12:12. [PMID: 30809275 PMCID: PMC6375221 DOI: 10.1186/s13047-019-0320-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits footwear choices and weight bearing activities. This paper aims to review non-surgical interventions for MN, to evaluate the evidence base for the clinical management of MN. METHODS Electronic biomedical databases (CINAHL, EMBASE, MEDLINE and Cochrane) were searched to January 2018 for studies evaluating the effectiveness of non-surgical interventions for Morton's neuroma. Outcome measures of interest were treatment success rate (SR) (binary) and pain as measured using 100-point visual analogue scale (VAS) (continuous). Studies with and without control groups were included and were evaluated for methodological quality using the Downs and Black Quality Index. Results from randomised controlled trials (RCT) were compared between-groups, and case series were compared pre- versus post-treatment. Effect estimates are presented as odds ratios (OR) for binary data or mean differences (MD) for continuous data. Random effects models were used to pool effect estimates across studies where similar treatments were used. Heterogeneity was assessed using the I 2 statistic. RESULTS A total of 25 studies met the inclusion criteria, seven RCTs and 18 pre/post case series. Eight different interventions were identified, with corticosteroid or sclerosing injections being the most often reported (seven studies each). Results from a meta-analysis of two RCTs found corticosteroid injection decreased pain more than control on VAS (WMD: -5.3, 95%CI: -7.5 to - 3.2). Other RCTs reported efficacy of: manipulation/mobilisation versus control (MD: -15.3, 95%CI: -29.6 to - 1.0); extracorporeal shockwave therapy versus control (MD: -5.9, 95%CI: -21.9 to 10.1). Treatment success was assessed for extracorporeal shockwave therapy versus control (OR: 0.3, 95%CI: 0.0 to 7.1); and corticosteroid injection vs footwear/padding (OR: 6.0, 95%CI: 1.9 to 19.2). Sclerosing and Botox injections, radiofrequency ablation and cryoneurolysis have been investigated by case series studies, however these were of limited methodological quality. CONCLUSIONS Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. Although the evidence base is expanding, further high quality RCTs are needed.
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Affiliation(s)
- Barry G. Matthews
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059 Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Michael P. Harding
- School of Health Sciences, University of South Australia, Adelaide, SA 5000 Australia
| | - Rachel A. Henry
- Rachel Henry Podiatry, Clayfield, Brisbane, QLD 4011 Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111 Australia
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20
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Santiago FR, Muñoz PT, Pryest P, Martínez AM, Olleta NP. Role of imaging methods in diagnosis and treatment of Morton's neuroma. World J Radiol 2018; 10:91-99. [PMID: 30310543 PMCID: PMC6177560 DOI: 10.4329/wjr.v10.i9.91] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/21/2018] [Accepted: 08/04/2018] [Indexed: 02/06/2023] Open
Abstract
Among the many causes of forefoot pain, Morton's neuroma (MN) is often suspected, particularly in women, due to its high incidence. However, there remain controversies about its relationship with symptomatology and which diagnostic and treatment choices to choose. This article mainly focuses on the role of the various imaging methods and their abilities to support an accurate diagnosis of MN, ruling out other causes of forefoot pain, and as a way of providing targeted imaging-guided therapy for patients with MN.
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Affiliation(s)
- Fernando Ruiz Santiago
- Radiology Department, Hospital of Neuro-Traumatology (Virgen de las Nieves), Granada 18014, Spain
| | - Pablo Tomás Muñoz
- Radiology Department, Hospital of Neuro-Traumatology (Virgen de las Nieves), Granada 18014, Spain
| | - Patel Pryest
- Radiology Department, North Tyneside General Hospital, North Shields NE29 8NH, United Kingdom
| | | | - Nicolás Prados Olleta
- Orthopaedic Department, Hospital of Neuro-Traumatology (Virgen de las Nieves), Granada 18014, Spain
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21
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Ahrar K, Sabir SH, Yevich SM, Sheth RA, Ahrar JU, Tam AL, Stafford JR. MRI-Guided Interventions in Musculoskeletal System. Top Magn Reson Imaging 2018; 27:129-139. [PMID: 29870465 DOI: 10.1097/rmr.0000000000000151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Image-guided interventions in the musculoskeletal system require accurate detection and characterization of lesions involving bone and soft tissues. Magnetic resonance imaging (MRI) has superior soft tissue contrast resolution particularly in bone and soft tissues where computed tomography and ultrasonography have significant limitations. In addition, the multiplanar imaging capabilities of MRI facilitate targeting lesions and tracking interventional devices. Although conventional diagnostic MRI sequences suffer from motion sensitivity and prolonged imaging time, recently developed fast imaging sequences allow for rapid acquisition of high-quality images, rendering MRI more suitable for image-guided interventions. Although computed tomography and ultrasonography still dominate the spectrum of image-guided interventions in the musculoskeletal system, many MRI-guided procedures have been developed and are well established in routine clinical work. In addition, new techniques and novel MRI-guided applications are being developed to address complex clinical problems in a minimally invasive fashion.
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Affiliation(s)
| | | | | | | | | | | | - Jason R Stafford
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX
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23
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Cazzato RL, Garnon J, Shaygi B, Tsoumakidou G, Caudrelier J, Koch G, Gangi A. How to Perform a Routine Cryoablation Under MRI Guidance. Top Magn Reson Imaging 2018; 27:33-38. [PMID: 29406413 DOI: 10.1097/rmr.0000000000000158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the last decade, the spectrum of interventional magnetic resonance imaging (MRI)-guided procedures, including percutaneous ablation, has substantially grown, and among the available MRI-compatible ablative techniques, cryoablation is progressively gaining a predominant position.The aim of the present narrative review is to discuss the technical requirements necessary to perform a percutaneous MRI-guided cryoablation in a closed-bore machine; to highlight the relative advantages and drawbacks; and to briefly summarize the results available in the literature.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Behnam Shaygi
- Interventional Radiology Department, Royal Devon and Exeter Hospital NHS Trust, Exeter, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
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Masala S, Cuzzolino A, Morini M, Raguso M, Fiori R. Ultrasound-Guided Percutaneous Radiofrequency for the Treatment of Morton's Neuroma. Cardiovasc Intervent Radiol 2017; 41:137-144. [PMID: 28956110 DOI: 10.1007/s00270-017-1786-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/31/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Morton's neuroma (MN) is a leading cause of disability. The purpose of this study was to investigate the effectiveness of radiofrequency (RF) in patients with chronic pain refractory to conservative therapies. METHODS Between September 2012 and December 2016, RF was performed on 52 patients. A sterile RF needle probe (22G, 5-cm needle with 10-mm electrode active tip) was inserted between the toes into the intermetatarsal space at the center of the lesion. Potential complications of the intervention and post-procedure care were examined. All patients provided written, informed consent. All percutaneous procedures were performed with the NeuroTherm® NT1100 (Neurotherm Inc., M.) device and using ultrasound guidance (Philips IU22). Continuous RF was performed with one cycle of 90 s and with the probe tip maintaining a temperature of 85 °C (impedance 95-210 mΩ). RESULTS Mean VAS score before the procedures was 9.0 ± 0.6. A reduction of pain intensity was achieved after 1 week by RF (mean VAS scores 3.7 ± 0.9; p < 0.05), with a stabilization of the painful symptomatology in the following months and after 1 year of treatments (mean VAS scores 2.0 ± 0.4 after 12 months, p < 0.05). The FHSQ scores showed improved quality of life (QOL) in all patients at 6 months (p < 0.05) and 1 year (p < 0.05) of RF. No patients developed complications. CONCLUSIONS RF is a safe, efficient, and minimally invasive technique for the treatment of symptomatic MN.
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Affiliation(s)
- Salvatore Masala
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Alessandro Cuzzolino
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Marco Morini
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Mario Raguso
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Fiori
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, Arrigoni F, Zugaro L, Barile A, Masciocchi C, Gangi A. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol 2016; 33:140. [PMID: 27837451 DOI: 10.1007/s12032-016-0848-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/22/2016] [Indexed: 12/12/2022]
Abstract
Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
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