Cryoanalgesia of the anterior femoral cutaneous nerve (AFCN) for the treatment of neuropathy-mediated anterior thigh pai
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TECHNICAL REPORT
Cryoanalgesia of the anterior femoral cutaneous nerve (AFCN) for the treatment of neuropathy-mediated anterior thigh pain: anatomy and technical description Danoob Dalili 1,2 & Shivani Ahlawat 2 & Ali Rashidi 2 & Allan J. Belzberg 3 & Jan Fritz 4 Received: 9 August 2020 / Revised: 12 October 2020 / Accepted: 13 October 2020 # ISS 2020
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 widebore 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 AFCNmediated neuropathic pain relief. Keywords Cryoablation . Nerve . Interventional MRI . Anterior cutaneous femoral nerve . Neuropathy . Neuralgia . Thigh pain
Introduction The anterior femoral cutaneous nerve (AFCN) is a small branch of the femoral nerve that provides sensory innervation * Jan Fritz [email protected] Danoob Dalili [email protected] Shivani Ahlawat [email protected] Ali Rashidi [email protected] Allan J. Belzberg [email protected]
to most of the anteromedial and anterior thigh (Fig. 1) [1]. AFCN injury and neuropathy typically manifest as pain, dysesthesia, and paresthesia over the anteromedial thigh, whereas the anterolateral thigh, groin, buttocks, and posterior 1
Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
2
Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, U
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