Percutaneous MR-Guided Cryoablation of Morton’s Neuroma: Rationale and Technical Details After the First 20 Patients
- 463 Downloads
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.
KeywordsMorton’s neuroma Magnetic resonance imaging Interventional Cryosurgery Percutaneous ablation technique
Compliance with Ethical Standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest. Authors #1, #3, #5, #6, #7, #8 and #9 have no conflict of interest to disclose. Authors #2, #4 and #10 are proctor for Galil Medical, Inc.
Human and animal rights informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Informed consent was obtained from all individual participants included in the study.
- 5.Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev. 2004;3(3):1–14.Google Scholar
- 9.Bauer T, Gaumetou E, Klouche S, Hardy P, Maffulli N. Metatarsalgia and Morton’s disease: comparison of outcomes between open procedure and neurectomy versus percutaneous metatarsal osteotomies and ligament release with a minimum of 2 years of follow-up. J Foot Ankle Surg. 2015;54(3):373–7.CrossRefPubMedGoogle Scholar
- 24.Schouten MG, Hoeks CM, Bomers JG, Hulsbergen-van de Kaa CA, Witjes JA, Thompson LC, Rovers MM, Barentsz JO, Fütterer JJ. Location of prostate cancers determined by multiparametric and MRI-guided biopsy in patients with elevated prostate-specific antigen level and at least one negative transrectal ultrasound-guided biopsy. Am J Roentgenol. 2015;205(1):57–63.CrossRefGoogle Scholar
- 25.Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, Saad WA, Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36.CrossRefPubMedGoogle Scholar
- 26.Sunderland S. Nerve and nerve injuries. 2nd ed. New York: Churchill Livingstone; 1978.Google Scholar
- 29.Coughlin MJ, Pinsonneault T. Operative treatment of interdigital neuroma. A long-term follow-up study. J Bone Jt Surg Am. 2001;83:1321–8.Google Scholar
- 33.Schreiber K, Khodaee M, Poddar S, Tweed EM. Clinical inquiry. What is the best way to treat Morton’s neuroma? J Fam Pract. 2011;60(3):157–8, 168.Google Scholar