SIR 2024
Pediatric Interventions
Anne Gill, MD (she/her/hers)
Associate Professor
Emory University
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Jeffrey Bodner, MD
Interventional Radiology Resident
Vanderbilt University
Financial relationships: Full list of relationships is listed on the CME information page.
C. Matthew Hawkins, MD
Associate Professor of Radiology
Emory University School of Medicine
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A retrospective analysis from 2018-2023 of a single pediatric healthcare system identified 27 cryoneurolysis procedures on 20 patients (16F/4M), median age 17yr. All procedures were done under general anesthesia and used a combination of fluoroscopy, CT, and/or ultrasound for image guidance. A variety of cryoablation probe sizes were used; all procedures had two freeze cycles with subsequent passive thaw cycles. Subjective improvement in pain was observed in 25/27 cases . Objective measures for procedural success included decreased opioid requirements or home discharge with hospice. There were no major or minor complications.
The most common indication was severe, refractory abdominal pain (secondary to MALS (n=7), POTS (n=5), and malignancy(n=2)) treated with bilateral splanchnic nerve ablation (17/23 cases. Two cases included refractory unilateral jaw pain with inferior alveolar nerve cryoneurolysis. One case was performed for post-operative unilateral facial pain with sphenopalatine ganglion cryoneurolysis. One patient with phantom limb pain was treated by targeting the median and ulnar nerve neuromas. Another patient with post-operative knee pain was treated with inferior medial genicular nerve cryoneurolysis. Lastly, one patient with widely metastatic osteosarcoma with lower limb paralysis and bowel/bladder incontinence had sciatic nerve cryoneurolysis in addition to multilevel lumbosacral nerve root ablation at L4-L5 and S1-S2.
Results:
Conclusion:
While there is some overlap in indications for cryoneurolysis in the adult and pediatric populations, severe non-malignant refractory abdominal pain is a more common indication in children/adolescents. In summary, cryoneurolysis has a wide variety of potential indications in children/adolescents and appears efficacious and safe based on findings from this small cohort.