Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Skeletal Radiol. 2021 Jun;50(6):1227-1236. doi: 10.1007/s00256-020-03650-2. Epub 2020 Oct 22.
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.
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 wide-bore 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.
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).
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 AFCN-mediated neuropathic pain relief.
描述和说明股前皮神经（AFCN）的磁共振成像（MRI）解剖结构，并介绍一种新的 AFCN 冷冻镇痛技术，用于治疗顽固性 AFCN 介导的神经性疼痛的长期镇痛治疗。
使用程序高分辨率 MRI 技术，我们描述了 AFCN 的 MRI 解剖结构。三名（平均年龄 48 岁；范围 41-67 岁）经选择性神经阻滞证实为顽固性 AFCN 介导的大腿前疼痛的患者入选接受 AFCN 冷冻镇痛。在 MRI 引导下，使用临床宽孔径磁共振成像系统和市售带有 MR 条件探针的冷冻消融系统进行手术。主要观察指标包括技术成功率、包括采用 11 点视觉模拟评分法评估的症状缓解在内的临床效果、并发症发生率和手术时间。
程序 MRI 能够成功地显示 AFCN 的走行、准确的冷冻探针放置和冰球监测，结果在所有病例中都成功地使冰球围绕 AFCN 生长。所有手术均具有临床效果，疼痛强度中位数从手术前的 8（7-9）分降至手术后的 1（0-2）分。在所有 3 名患者中，冷冻镇痛效果在 12 个月的随访期间持续存在。未发生重大并发症。平均总手术时间为 98 分钟（85-125 分钟）。
我们描述了 AFCN 的 MRI 解剖结构和一种新的 AFCN 冷冻镇痛技术，使用 MRI 引导，可识别 AFCN、选择性靶向和冰球监测，以实现长期的 AFCN 介导的神经性疼痛缓解。
