Percutaneous MR-Guided Cryoablation of Morton's Neuroma: Rationale and Technical Details After the First 20 Patients.

Abstract

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 50.3years) were included; 24 MN (mean size 12.7mm) were treated. Technical success was 100%. Mean procedural time was 40.9±10.4min (range 35-60). One minor complication (superficial cellulitis) was reported (4.2%). Follow-up (mean 19.7months) 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.