Cazzato Roberto Luigi, Garnon Julien, Ramamurthy Nitin, Tsoumakidou Georgia, Caudrelier Jean, Thenint Marie-Aude, Rao Pramod, Koch Guillaume, Gangi Afshin
Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l' Hôpital, 67000, Strasbourg, France.
Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
Cardiovasc Intervent Radiol. 2016 Oct;39(10):1491-8. doi: 10.1007/s00270-016-1365-7. Epub 2016 May 17.
The purpose of this study is to discuss technical aspects and rationales of magnetic resonance (MR)-guided cryoablation (CA) of Morton's neuroma (MN); preliminary clinical experience is also retrospectively reviewed.
Procedures were performed under local anaesthesia on an outpatient basis. Lesion size and location, procedural (technical success, procedural time, complications) and clinical outcomes (patient satisfaction according to a four-point scale, residual pain according to a 0-10 visual analogue scale and instances of "stump neuroma") were assessed via chart review and cross-sectional telephone survey after the 20th case.
Twenty patients (15 female, 5 male; mean age 50.3 years) were included; 24 MN (mean size 12.7 mm) were treated. Technical success was 100 %. Mean procedural time was 40.9 ± 10.4 min (range 35-60). One minor complication (superficial cellulitis) was reported (4.2 %). Follow-up (mean 19.7 months) was available for 18/24 MN. Patient satisfaction on a per-lesion basis was as follows: "completely satisfied" in 77.7 %, "satisfied with minor reservations" in 16.6 % and "satisfied with major reservations" in 5.7 % of cases. Mean pain score at last follow-up post-CA was 3.0. No instances of "stump neuroma" were reported.
MR-guided CA of MN is a novel therapy which appears technically feasible. Clinical advantages of the procedure are high patient satisfaction, reduced risk of "stump neuroma" syndrome and good patient tolerance on an outpatient basis. Further, prospective studies are needed to confirm these encouraging results.
本研究旨在探讨磁共振（MR）引导下跖间神经瘤（MN）冷冻消融（CA）的技术要点及原理；同时回顾性分析初步临床经验。
在门诊局部麻醉下实施手术。在第20例病例之后，通过病历回顾和横断面电话调查评估病变大小和位置、手术情况（技术成功率、手术时间、并发症）以及临床结果（根据四分制量表评估患者满意度、根据0-10视觉模拟量表评估残余疼痛以及“残端神经瘤”情况）。
纳入20例患者（15例女性，5例男性；平均年龄50.3岁）；共治疗24个MN（平均大小12.7毫米）。技术成功率为100%。平均手术时间为40.9±10.4分钟（范围35-60分钟）。报告了1例轻微并发症（浅表蜂窝织炎）（4.2%）。24个MN中有18个有随访资料（平均19.7个月）。基于每个病变的患者满意度如下：77.7%的病例“完全满意”，16.6%的病例“有轻微保留意见的满意”，5.7%的病例“有重大保留意见的满意”。CA术后最后一次随访时的平均疼痛评分为3.0。未报告“残端神经瘤”情况。
MR引导下MN的CA是一种新型治疗方法，在技术上似乎可行。该手术的临床优势包括患者满意度高、“残端神经瘤”综合征风险降低以及患者在门诊基础上耐受性良好。此外，需要进一步的前瞻性研究来证实这些令人鼓舞的结果。
