CT-guided cryoablation for palliation of secondary trigeminal neuralgia from head and neck malignancy

Background Facial pain is a common presentation secondary to tumoral invasion, rendering an individual unable to perform basic activities such as eating and talking. Cryotherapy may be appropriate in patients seeking immediate pain relief for trigeminal neuralgia (TN) near the end of life with its minimal invasiveness and procedural morbidity. While cryosurgery has been effectively demonstrated in the treatment of primary TN, this study is unique as it is the first documented use of CT guidance and treatment of secondary TN using percutaneous cryoablation. Aim To perform and report experience with CT-guided percutaneous cryoablation, a palliative treatment for TN secondary to recurrent invasive head and neck carcinoma, in patients previously treated with chemotherapy, radiotherapy and/or surgery with the goal of improving functional status and quality of life. Methods Palliative cryoablation procedures performed under CT guidance on recurrent head and neck malignancy between September 2010 and June 2011 were retrospectively analyzed. The procedure was performed under general anesthesia or conscious sedation. For each patient, 1-2 cryoprobes were placed in the tumor and two or four freeze-thaw cycles were performed. Patients were evaluated for facial pain relief immediately after treatment by telephone follow-up. Results Three patients underwent treatment for three masses using CT-guided percutaneous cryoablation. On imaging, technical success was achieved in all cases with hypodense ice formation encompassing symptomatic lesions on the CT scan. No procedural complications were encountered with post-procedure pain relief and reduction in required pain medication noted in all patients. One patient had 1 month of pain relief before the symptoms returned. Conclusion CT-guided percutaneous cryoablation is an efficient minimally invasive method for the palliative treatment of TN secondary to recurrent invasive head and neck carcinoma as a result of direct tumoral invasion of the extracranial divisions of the trigeminal nerve. Patients meeting the therapeutic criteria of individuals treated for musculoskeletal metastatic lesions may benefit from this treatment. The results suggest it may not currently be a curative technique as one patient's symptoms returned, but it could prove useful as an adjunct to current palliative therapies with minimal invasiveness and procedural morbidity, especially in patients seeking pain palliation, improved functional status and improved quality of life near the end of life.