761 - Image-Guided Cryoablation of Desmoid Fibromas in Pediatric Patients: A Safe and Effective Minimally Invasive Approach

Learning Objectives:

1. To illustrate through case presentation the importance of image-guided cryoablation in the evaluation and management of desmoid fibromas in pediatric patients


2. To raise awareness of the optimal imaging evaluation and safety techniques including neuromuscular monitoring and hydrodissection for nerve and skin protection during cryoablation procedures


3. Outline an approach to the multidisciplinary management of pediatric desmoid fibromas incorporating interventional radiology expertise and advanced ablative techniques

Background: Desmoid fibromas are a rare musculoskeletal tumor that are aggressive and characterized by infiltrative growth. Surgical resection and/or chemotherapy have traditionally been the standard of care for symptomatic patients {1-2}. Cryoablation has been shown to be effective in local control of extra-abdominal desmoid tumors while minimizing morbidity and preserving function {3}.

Clinical Findings/Procedure Details: We present a case series illustrating the anatomical locations treated, optimal imaging evaluation of these lesions and a variety of cryoablation techniques used to successfully manage pediatric desmoid fibromas as part of a multi-disciplinary team.

Cases presented include desmoid fibromas of the forearm, shoulder, leg, gluteal region, and abdominal wall managed with image-guided cryoablation. We demonstrate the critical importance of neuromuscular monitoring during procedures to prevent nerve injury and illustrate hydrodissection techniques for nerve and skin protection. Pre-procedural planning with MRI, real-time imaging guidance, probe positioning strategies, and post-ablation monitoring protocols will be detailed.

Conclusion and/or Teaching Points: Imaging and cryoablation procedures performed by pediatric interventional radiologists are critical in the multidisciplinary management of desmoid fibromas, providing effective tumor control while preserving function and minimizing surgical morbidity through careful attention to neuromuscular monitoring and protective hydrodissection techniques.