CT-guided cryoablation for palliation of secondary trigeminal neuralgia from head and neck malignancy

Abstract

CT-guided percutaneous cryoablation is an efficient minimally invasive method for the palliative treatment of TN secondary to recurrent invasive head and neck carcinoma as a result of direct tumoral invasion of the extracranial divisions of the trigeminal nerve. Patients meeting the therapeutic criteria of individuals treated for musculoskeletal metastatic lesions may benefit from this treatment. The results suggest it may not currently be a curative technique as one patient's symptoms returned, but it could prove useful as an adjunct to current palliative therapies with minimal invasiveness and procedural morbidity, especially in patients seeking pain palliation, improved functional status and improved quality of life near the end of life.

Image-guided Nerve Cryoablation for Post-thoracotomy Pain Syndrome

“…Percutaneous cryoablation for pain palliation has been performed in patients with neoplastic and metastatic disease in multiple organs, such as bone, kidney and prostate [2]. Cryoablation has also been used for patients with trigeminal [9] and genitofemoral neuralgia [5]. ICN cryoablation in particular has been described in randomized trials that compared surgical cryoanalgesia to narcotics during surgery or shortly after.…”

“…Cryoanalgesia therapy has been recently performed under ultrasound [6] and CT guidance [7]. While ultrasound may rapidly detect pneumothorax [6], iceball formation is better visualized on CT and CBCT [10].…”

“…Furthermore, cryoablation is less likely to cause neuroma formation than surgical or thermal nerve ablations since it does not damage the perineurium or epineurium [5]. While needle placement for ICN ablation is conventionally estimated by palpation of bony landmarks, recent success of cryoanalgesia under ultrasound [6] and CT [7] guidance has raised interest for imaged-guided ICN cryoanalgesia for PTPS. Nevertheless, experience in device navigation and ablation simulation in combination with image-guidance is limited in the field of cryoanalgesia.…”

Interventional Management of Head and Neck Tumors

“…Reported experience for cryoablation of head and neck tumors is limited to few reports. 83,88 Guenette et al reported a series of nine patients, where regional ablation for pain relief or functional status preservation was achieved in eight patients, with no associated mortality or permanent neurovascular or cosmetic morbidity. 83 In the head and neck region, direct visualization of the ablation zone is of value given the densely packed vital structures.…”

Percutaneous Image-Guided Cryoablation of Head and Neck Tumors for Local Control, Preservation of Functional Status, and Pain Relief

“…While CT-guided and MRI-guided percutaneous aspiration of head and neck tumors is well documented (10,11), the literature of head and neck ablation is sparse, limited primarily to case reports, and limited primarily to CT- and US-guided radiofrequency ablation (for example 12–15) with a few reported successful CT-guided cryoablation and MRI-guided laser-induced thermotherapy procedures (16,17). None of these techniques visualize the precise margins of ablation.…”