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ICE Cryoablation Technology

Cryoneurolysis

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Overview

Due to the opioid crisis, there is a growing need for alternate pain palliation methods for hard-to-treat neuropathies. Because of this, Interventional Radiologists (IRs) are playing an increasing role in the pain management space. The IR’s ability to percutaneously access otherwise unreachable nervous system structures, visualize and monitor ablation zones, and induce predictable neuroregeneration in clinical settings has unlocked a multitude of opportunities.

Cryoneurolysis nerve targets

image of skeleton with nerve targets labeled.

Interventional Radiologists must be aware of key nerve targets, have an in-depth understanding of which patients are candidates for image-guided percutaneous cryoneurolysis (PCA), and the differentiators between cryoablation and heat or alcohol-based neurolysis.

Pudendal Nerve
Morton's Neuroma
Dorsal Neuropathies
Limb Neuroma
Celiac Plexus
Trigeminal Nerve
Spanchnic Nerve

Case studies

Two IceRod 1.5 CX needles placed within and along the bilateral celiac plexus via CT-guidance.

Celiac Plexus Cryoneurolysis: Technical and Anatomic Considerations

A 66-year-old man presented with intractable upper abdominal pain refractory to medical management with opiates. MRI axial images through the celiac plexus at the celiac plexus at the level of the celiac axis and SMA origins demonstrate bulky retroperitoneal adenopathy and soft tissue tumor infiltrate. Two IceRod™ 1.5 CX needles were placed within and along the bilateral celiac plexus via CT-guidance. The CT Axial image (right) in prone position shows right-sided iceball formation along the celiac plexus demonstrating excellent coverage. The patient reported pain at 2/10 after a 3-day follow-up pain assessment; the pain score before the procedure was a 10/10.

Aron Chary, MD I MidSouth Imaging - Vascular Interventional Physicians I Memphis, TN

Two IceRod 1.5 CX needles were placed along the celiac plexus bilaterally resulting in lower pain, improved appetite, better sleep and reduced constipation for the patient.

Celiac Plexus Cryoneurolysis Utilized to Treat Abdominal Pain from Pancreatic Caner

A 79-year-old man presented with abdominal pain radiating to his back. He was referred to Interventional Radiology by his Medical Oncologist for a ‘celiac plexus block.’ Two IceRod™ 1.5 CX needles were placed along the course of the celiac plexus bilaterally. The patient experienced mild orthostatic hypotension in the recovery area, a typical transient phenomenon with this treatment. The patient was seen in post-operative clinic one week after the procedure. Pain was down to 3/10 (VAS) from 8/10 (VAS) pre-op with improved appetite, better sleep, and reduced constipation. The pain relief typically last approximately 6-12 months, and the procedure can be repeated should the pain return.

Robert Evans Heithaus, MD I Vascular and Interventional Radiologist University of Florida I Gainesville, FL

Resources

PDF Cryoneurolysis for Pancreatic Cancer Pain case study

PDF Sciatic and Femoral Nerve Cryoablation case study

PDF Celiac Plexus Cryoneurolysis case study

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