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Ultrasound-guided microwave ablation in the treatment of inguinal neuralgia

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Abstract

Chronic groin pain can be due to a variety of causes and is the most common complication of inguinal hernia repair surgery. The etiology of pain after inguinal hernia repair surgery is often multifactorial though injury to or scarring around the nerves in the operative region, namely the ilioinguinal nerve, genital branch of the genitofemoral nerve, and the iliohypogastric nerve, is thought to be a key factor in causing chronic post-operative hernia pain or inguinal neuralgia. Inguinal neuralgia is difficult to treat and requires a multidisciplinary approach. Radiologists play a key role in the management of these patients by providing accurate image-guided injections to alleviate patient symptoms and identify the pain generator. Recently, ultrasound-guided microwave ablation has emerged as a safe technique, capable of providing durable pain relief in the majority of patients with this difficult to treat condition. The objectives of this paper are to review the complex nerve anatomy of the groin, discuss diagnostic ultrasound-guided nerve injection and patient selection for nerve ablation, and illustrate the microwave ablation technique used at our institution.

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Authors and Affiliations

  1. Department of Radiology, NYU Langone Heath, 660 First Avenue, New York, NY, 10016, USA

    Steven P. Daniels

  2. Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA

    Helen S. Xu

  3. Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Amgad Hanna

  4. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Jacob A. Greenberg

  5. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Kenneth S. Lee

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  1. Steven P. Daniels
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  4. Jacob A. Greenberg
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Correspondence to Steven P. Daniels.

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Conflict of interest

Dr. Lee discloses grants from National Basketball Association-General Electric and Mitek, research support from Supersonic Imagine and royalties from Elsevier.

Dr. Hanna discloses royalties from Springer and Thieme.

Dr. Greenberg participates in clinical trials run by Medtronic and BD Interventional.

Dr. Daniels and Dr. Xu have no disclosures.

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Daniels, S.P., Xu, H.S., Hanna, A. et al. Ultrasound-guided microwave ablation in the treatment of inguinal neuralgia. Skeletal Radiol 50, 475–483 (2021). https://doi.org/10.1007/s00256-020-03618-2

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  • DOI: https://doi.org/10.1007/s00256-020-03618-2

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