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High-resolution magnetic resonance-guided posterior femoral cutaneous nerve blocks

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Abstract

Objective

To assess the feasibility, technical success, and effectiveness of high-resolution magnetic resonance (MR)-guided posterior femoral cutaneous nerve (PFCN) blocks.

Materials and methods

A retrospective analysis of 12 posterior femoral cutaneous nerve blocks in 8 patients [6 (75 %) female, 2 (25 %) male; mean age, 47 years; range, 42–84 years] with chronic perineal pain suggesting PFCN neuropathy was performed. Procedures were performed with a clinical wide-bore 1.5-T MR imaging system. High-resolution MR imaging was utilized for visualization and targeting of the PFCN. Commercially available, MR-compatible 20-G needles were used for drug delivery. Variables assessed were technical success (defined as injectant surrounding the targeted PFCN on post-intervention MR images) effectiveness, (defined as post-interventional regional anesthesia of the target area innervation downstream from the posterior femoral cutaneous nerve block), rate of complications, and length of procedure time.

Results

MR-guided PFCN injections were technically successful in 12/12 cases (100 %) with uniform perineural distribution of the injectant. All blocks were effective and resulted in post-interventional regional anesthesia of the expected areas (12/12, 100 %). No complications occurred during the procedure or during follow-up. The average total procedure time was 45 min (30–70) min.

Conclusions

Our initial results demonstrate that this technique of selective MR-guided PFCN blocks is feasible and suggest high technical success and effectiveness. Larger studies are needed to confirm our initial results.

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References

  1. Gray H, Lewis WH. Anatomy of the human body. 20th ed. New York: Bartleby.com; 2000.

    Google Scholar 

  2. Mobbs RJ, Szkandera B, Blum P. Posterior femoral cutaneous nerve entrapment neuropathy: operative exposure and technique. Br J Neurosurg. 2002;16(3):309–11.

    Article  PubMed  CAS  Google Scholar 

  3. Tubbs RS, Miller J, Loukas M, Shoja MM, Shokouhi G, Cohen-Gadol AA. Surgical and anatomical landmarks for the perineal branch of the posterior femoral cutaneous nerve: implications in perineal pain syndromes. Laboratory investigation. J Neurosurg. 2009;111(2):332–5.

    Article  PubMed  Google Scholar 

  4. Darnis B, Robert R, Labat JJ, et al. Perineal pain and inferior cluneal nerves: anatomy and surgery. Surg Radiol Anat. 2008;30(3):177–83.

    Article  PubMed  CAS  Google Scholar 

  5. Arnoldussen WJ, Korten JJ. Pressure neuropathy of the posterior femoral cutaneous nerve. Clin Neurol Neurosurg. 1980;82(1):57–60.

    Article  PubMed  CAS  Google Scholar 

  6. Chutkow JG. Posterior femoral cutaneous neuralgia. Muscle Nerve. 1988;11(11):1146–8.

    Article  PubMed  CAS  Google Scholar 

  7. Dumitru D, Marquis S. Posterior femoral cutaneous nerve neuropathy and somatosensory evoked potentials. Arch Phys Med Rehabil. 1988;69(1):44–5.

    PubMed  CAS  Google Scholar 

  8. Gomceli YB, Kapukiran A, Kutlu G, Kurt S, Baysal AI. A case report of an uncommon neuropathy: posterior femoral cutaneous neuropathy. Acta Neurol Belg. 2005;105(1):43–5.

    PubMed  Google Scholar 

  9. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7.

    Article  PubMed  CAS  Google Scholar 

  10. Obach J, Aragones JM, Ruano D. The infrapiriformis foramen syndrome resulting from intragluteal injection. J Neurol Sci. 1983;58(1):135–42.

    Article  PubMed  CAS  Google Scholar 

  11. Schaeffer AJ. Etiology and management of chronic pelvic pain syndrome in men. Urology. 2004;63(3 Suppl 1):75–84.

    Article  PubMed  Google Scholar 

  12. Wesselmann U, Burnett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain. 1997;73(3):269–94.

    Article  PubMed  CAS  Google Scholar 

  13. Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus. 2009;26(2):E9.

    Article  PubMed  Google Scholar 

  14. Hughes PJ, Brown TC. An approach to posterior femoral cutaneous nerve block. Anaesth Intensive Care. 1986;14(4):350–1.

    PubMed  CAS  Google Scholar 

  15. Barbero C, Fuzier R, Samii K. Anterior approach to the sciatic nerve block: adaptation to the patient’s height. Anesth Analg. 2004;98(6):1785–8.

    Article  PubMed  Google Scholar 

  16. Chelly JE, Delaunay L. A new anterior approach to the sciatic nerve block. Anesthesiology. 1999;91(6):1655–60.

    Article  PubMed  CAS  Google Scholar 

  17. De Tran QH, Clemente A, Finlayson RJ. A review of approaches and techniques for lower extremity nerve blocks. Can J Anaesth. 2007;54(11):922–34.

    Article  PubMed  Google Scholar 

  18. Chhabra A, Williams EH, Wang KC, Dellon AL, Carrino JA. MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. Am J Neuroradiol. 2010;31(8):1363–8.

    Article  PubMed  CAS  Google Scholar 

  19. Thawait SK, Wang K, Subhawong TK, et al. Peripheral nerve surgery: the role of high-resolution MR neurography. AJNR Am J Neuroradiol. 2012;33(2):203–10.

    Article  PubMed  CAS  Google Scholar 

  20. Chhabra A, Lee PP, Bizzell C, Soldatos T. 3 Tesla MR neurography–technique, interpretation, and pitfalls. Skeletal Radiol. 2011;40(10):1249–60.

    Article  PubMed  Google Scholar 

  21. Chhabra A, Soldatos T, Andreisek G. Lumbosacral Plexus. In: Chhabra A, Andreisek G, editors. Magnetic resonance neurography. New Delhi: Jaypee Brothers Medical Publishers; 2012. pp. 161–81.

    Chapter  Google Scholar 

  22. Fritz J, Thomas C, Clasen S, Claussen CD, Lewin JS, Pereira PL. Freehand real-time MRI-guided lumbar spinal injection procedures at 1.5 T: feasibility, accuracy, and safety. Am J Roentgenol. 2009;192(4):W161–7.

    Article  Google Scholar 

  23. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.

    Article  PubMed  Google Scholar 

  24. Lewin JS, Duerk JL, Jain VR, Petersilge CA, Chao CP, Haaga JR. Needle localization in MR-guided biopsy and aspiration: effects of field strength, sequence design, and magnetic field orientation. AJR Am J Roentgenol. 1996;166(6):1337–45.

    PubMed  CAS  Google Scholar 

  25. Fritz J, Niemeyer T, Clasen S, et al. Management of chronic low back pain: rationales, principles, and targets of imaging-guided spinal injections. Radiographics. 2007;27(6):1751–71.

    Article  PubMed  Google Scholar 

  26. Shetty SK, Nelson EN, Lawrimore TM, Palmer WE. Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction. Skeletal Radiol. 2007;36(4):301–7.

    Article  PubMed  Google Scholar 

  27. Safriel Y, Ali M, Hayt M, Ang R. Gadolinium use in spine procedures for patients with allergy to iodinated contrast–experience of 127 procedures. Am J Neuroradiol. 2006;27(6):1194–7.

    PubMed  CAS  Google Scholar 

  28. Fritz J, Henes JC, Thomas C, et al. Diagnostic and interventional MRI of the sacroiliac joints using a 1.5-T open-bore magnet: a one-stop-shopping approach. AJR Am J Roentgenol. 2008;191(6):1717–24.

    Article  PubMed  Google Scholar 

  29. Fritz J, Thainual P, Ungi T, et al. Augmented reality visualization with image overlay for MRI-guided intervention: accuracy for lumbar spinal procedures with a 1.5-T MRI system. AJR Am J Roentgenol. 2012;198(3):W266–73.

    Article  PubMed  Google Scholar 

  30. Wacker FK, Vogt S, Khamene A, et al. An augmented reality system for MR image-guided needle biopsy: initial results in a swine model. Radiology. 2006;238(2):497–504.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA

    Jan Fritz, Cary Bizzell, Sudhir Kathuria, John A. Carrino & Avneesh Chhabra

  2. Siemens Corporate Research, Center for Applied Medical Imaging, 855 N. Wolfe St., Baltimore, MD, USA

    Aaron J. Flammang

  3. Department of Plastic, Reconstructive, and Maxillofacial Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA

    Eric H. Williams

  4. Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA

    Allan J. Belzberg

  5. Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., JHOC 5165, Baltimore, MD, 21287, USA

    Jan Fritz

  6. Dellon Institute for Peripheral Nerve Surgery, 1122 Kenilworth Dr Suite 18, Towson, MD, 21204, USA

    Eric H. Williams

Authors
  1. Jan Fritz
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  2. Cary Bizzell
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  3. Sudhir Kathuria
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  4. Aaron J. Flammang
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  5. Eric H. Williams
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  6. Allan J. Belzberg
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  7. John A. Carrino
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  8. Avneesh Chhabra
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Corresponding author

Correspondence to Jan Fritz.

Additional information

Presented, in part, at the 39th Annual Meeting of the International Skeletal Society, 12–15 September, 2012 in Rome, Italy.

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Fritz, J., Bizzell, C., Kathuria, S. et al. High-resolution magnetic resonance-guided posterior femoral cutaneous nerve blocks. Skeletal Radiol 42, 579–586 (2013). https://doi.org/10.1007/s00256-012-1553-8

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  • DOI: https://doi.org/10.1007/s00256-012-1553-8

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