A Technical Report on the Performance of Percutaneous Cryoneurolysis of Splanchnic Nerves for the Treatment of Refractory Abdominal Pain in Patients with Pancreatic Cancer: Initial Experience.

PURPOSE: To report our preliminary results upon feasibility, efficacy and safety of percutaneous splanchnic nerves cryoneurolysis for the treatment of abdominal pain refractory to conservative medication in patients with pancreatic cancer MATERIALS METHODS: Institutional database research (retrospective review of prospectively collected data from April 2019 till August 2020) identified 5 patients with pancreatic cancer and pain refractory to conservative medication who underwent percutaneous cryoneurolysis of splanchnic nerves. In all patients, percutaneous cryoneurolysis was performed with posterolateral paravertebral approach using a 17 Gauge cryoprobe under computed tomography guidance and local anesthesia. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with visual analog scale (VAS) units. RESULTS: Mean patient age was 63.81 years (male-female: 3-2). Mean pain score prior to cryoanalgesia of splanchnic nerves was 9.4 VAS units. This score was reduced to a mean value of 2.6, 2.6 and 3 VAS units at 1, 3 and 6 months of follow-up, respectively. All patients reported significantly reduced analgesic usage. No complication was reported according to the CIRSE classification system. The mean procedure time was 44.4 min (range 39-50 min), including local anesthesia, cryoprobe(s) placement, ablation and post-procedural CT evaluation. CONCLUSION: Percutaneous cryoanalgesia of the splanchnic nerves is a minimally invasive, safe and effective procedure for pancreatic cancer pain relief. A larger, randomized trial is justified to substantiate these findings.

Percutaneous cryoanalgesia for pain palliation: Current status and future trends.

Cryoanalgesia, otherwise termed cryoneurolysis, refers to application of extreme cold upon peripheral nerves for palliation of pain associated to nerve lesions or biomechanical syndromes of neoplastic and non-neoplastic substrate. Application of cryoanalgesia initiates a cascade of pathophysiologic events interrupting nerve conduction of painful stimuli without irreversible nerve damage. Cryoanalgesia is considered a safe procedure with minimal risk of complications when performed with percutaneous approaches under imaging guidance. In the era of an opioid overdose crisis, cryoanalgesia can be proposed as an alternative aiming at controlling pain and improving life quality. Imaging guidance has substituted open surgical and nerve stimulation approaches in nerve identification, significantly contributing to the minimally invasive character of percutaneous approaches. Ultrasound or computed tomography can serve as low cost, ideal guiding techniques due to their abilities for precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to become familiar with the most common imaging guided percutaneous cryoanalgesia indications, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed.

Incidence and morphometry of caroticoclinoid foramina in Greek dry human skulls.

BACKGROUND: Ossification of the caroticoclinoid ligament (CCL) and formation of a caroticoclinoid foramen (CCF) may impose significant risk to neurosurgeons by impeding mobilization of the cavernous segment of the internal carotid artery. Although safe surgical access to the clinoidal space is related to understanding the CCF anatomical and ethnic variants, there remains a paucity of studies of the morphology and bony relationships. The current study provides a systematic morphological and morphometric analysis of the CCF, the ossification of the CCL extending between the anterior and middle clinoid processes, and their relations in a Greek population. MATERIALS AND METHODS: The incidence of unilateral and bilateral CCF, types (complete, incomplete, and contact) of ossified CCLs, and foramina diameter according to side and gender were determined in 76 Greek adult dry skulls. Findings were correlated with the morphology of optic strut (OS) (presulcal, sulcal, postsulcal, and asymmetric). RESULTS: A CCF was detected in 74% of the specimens. The majority of skulls (51.4%) had bilateral CCF, whereas 22.3% of the skulls had unilateral foramina. Incomplete CCF were observed in 69.3%, complete in 19.8%, and contact type in 10.9%. The mean CCF diameter was 0.55 ± 0.07 cm on the left and 0.54 ± 0.08 cm on the right side. Side symmetry existed, although there were no significant differences according to gender. The CCF were more prominent in skulls with a sulcal type of OS. CONCLUSIONS: The results of the present study augment the current knowledge on the morphology of key anatomical landmarks, CCF, and CCL ossification in the sellar area, indicating population differences. A significant side asymmetry in caroticoclinoid osseous bridging and foramina is highlighted. These findings are necessary for a safe surgical access to the clinoidal area.

Isoprinosine delays the early appearance of autoimmunity in NZB/NZW F1 mice treated with interferon.

NZB/NZW F1 hybrid mice treated for long periods with type beta interferon developed early symptoms of autoimmune disease. In these animals the level of anti-dsDNA antibody begins to increase at 4-6 months while untreated NZB/NZW mice do not display similar levels until 12 months. The concomitant administration of isoprinosine and interferon delays the early appearance of autoimmune disorders. In interferon-treated NZB/NZW mice the cytotoxic activity of natural killer lymphocytes is maintained at high levels until the age of 5 months. Nevertheless, the natural killer activity is even stronger and detected until at least 7 months in NZB/NZW mice receiving a single dose of interferon 16 hr prior to the test. Lymphoblastoid ascitic tumours appeared early (2-3 months) during interferon treatment in all groups of NZB/NZW mice. However, in the presence of isoprinosine only a few animals developed tumours. Thus, isoprinosine seems to protect NZB/NZW mice both from early autoimmune disorders due to interferon and from early tumour development.

Adverse effects of interferon treatment on the life span of NZB mice.

NZB mice treated with interferon from birth and for over a year, display early some characteristics of the autoimmune disease. In these animals, mortality is clearly higher than in controls. Their death occurs 3 to 6 months before that of mice injected with a "mock" preparation.