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Keywords:
Interventional non-vascular, Oncology, CT, Percutaneous, Ablation procedures, Cancer, Metastases
Authors:
E. Mavrovi, M. Cuinet, B. Richioud, C. Mastier, F. Pilleul, G. Chvetzoff, A.-C. Kalenderian; Lyon/FR
DOI:
10.1594/ecr2016/B-0128
Methods and materials
From January 2012 to June 2014,
32 cryoneurolysis of chest intercostal nerves secondary to carcinoma metastasis or sarcoma metastasis were performed on 12 patients (six men,
six women; mean age: 60 years,
range: 17-79) with neurological pain and failure of third level opioid treatment.
Chest nerve roots incriminated of the pain were determined after clinical examination and confirmed by recent CT or MRI exams ( Fig. 1 ).
Relief of pain through the use of pain treatment or medications was recorded on a 0%-100% scale (0%,
no relief; 100% complete relief).
Specific contraindications were secondary thoracic epidural infiltration or whole metastatic infiltration of the vertebra ( Fig. 2 ).
Cryoneurolysis was done under CT guidance under general anesthesia or neuroleptanalgesia. A carbodissection of the epidural space was performed at the beginning of each procedure in order to protect the spinal cord and prejudicial ice side effects ( Fig. 3,
7).
A single cryoprobe (ice Rod® or ice sphere® -Galil,
Arden Hills,
Minnesota,
US) was placed by each chest wall root's need to be freeze.
A single freeze-thaw-freeze cycle was performed for each root,
and a time of 10 minutes,
8 minutes,
and 10 minutes,
respectively,
was intended for the cycle.
Unenhanced CT imaging was performed approximately every 2 minutes throughout the freezing portions of the cycle to monitor the growth of the ice ball.
It not only permits to monitor the freezing but also the CO2 thermal insulator blanket,
which may necessitate repeated injections ( Fig. 4 ).
After completion of the final freeze of the cryoneurolysis procedure,
the cryoprobes were warmed with active heating by using helium gas until the temperature reached >20 C°.
Then the cryoprobes were withdrawn.
Pain medication use immediately after the procedure and throughout the hospital stay was recorded for each patient who was treated.