The percutaneous anterior approach to the celiac plexus using CT guidance

Matamala, Antonio Montero; Lopez, F. Vidal; Martinez, Luis Inaraja

doi:10.1016/0304-3959(88)90124-8

Cited by 63 publications

(12 citation statements)

References 12 publications

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“…this technique. Interest in this technique has been regenerated, however, by introductions of the CT-guided approach, described by Matamala et al [7].…”

Section: The First Anterior Percutaneous Approachmentioning

confidence: 98%

The development of a technique for radiofrequency lesioning of splanchnic nerves

Raj

Thomas

Heavner

et al. 1999

Current Review of Pain

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This article describes the development of a technique for radiofrequency lesioning of the splanchnic nerves. It features point neurolysis and improvement in safety from previously described techniques with the use of a curved, blunt needle. After extensive anatomic studies, the site of entry has been identified 4 cm lateral to the spinous process at the costovertebral angle of either the T11 or T12 vertebral body, and the placement of the needle tip at the junction of posterior two thirds to the anterior one third of the vertebral body. The use of a sharp, straight needle has been discouraged to prevent pneumothorax, and bowel, kidney, or nerve root injury. The radiofrequency lesion permits a point neurolysis, thus decreasing the rate of complications. Our experience of 22 patients treated with this technique has been complication-free, and the outcome was effective for all 10 patients with cancer. In the nonmalignancy group, some patients needed a second neurolysis (radiofrequency) procedure 4 months apart. There were also no secondary complications in these patients. We expect multicenter data accumulation in the coming years, which will determine the true efficacy of the radiofrequency of splanchnic nerves.

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“…this technique. Interest in this technique has been regenerated, however, by introductions of the CT-guided approach, described by Matamala et al [7].…”

Section: The First Anterior Percutaneous Approachmentioning

confidence: 98%

The development of a technique for radiofrequency lesioning of splanchnic nerves

Raj

Thomas

Heavner

et al. 1999

Current Review of Pain

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“…Complications of celiac plexus block are usually minimal but may include pain, hypotension and transient diarrhea paraplegia, and abdominal, aortic dissection (Matamala et al, 1988;Kurdziel and Dondelinger, 1990;Lieberman and Waldman, 1990;Romanelli et al, 1993;Suleyman Ozyalcin et al, 2004;Strong et al, 2006), while the response to the block is directly correlated to the degree of plexus invasion by the tumor (Akhan et al, 1997). In severe cases of pancreatic cancer pain, an indwelling catheter, placed in the retroperitoneal space near the celiac plexus, enables the physician to perform repeated alcohol celiac plexus blocks (Hilgier and Rykowski, 1994;Rykowski and Hilgier, 1995;Vranken et al, 2001).…”

Section: Celiac Plexus Blockmentioning

confidence: 99%

A review of the thoracic splanchnic nerves and celiac ganglia

et al. 2010

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Anatomical variation of the thoracic splanchnic nerves is as diverse as any structure in the body. Thoracic splanchnic nerves are derived from medial branches of the lower seven thoracic sympathetic ganglia, with the greater splanchnic nerve comprising the more cranial contributions, the lesser the middle branches, and the least splanchnic nerve usually T11 and/or T12. Much of the early anatomical research of the thoracic splanchnic nerves revolved around elucidating the nerve root level contributing to each of these nerves. The celiac plexus is a major interchange for autonomic fibers, receiving many of the thoracic splanchnic nerve fibers as they course toward the organs of the abdomen. The location of the celiac ganglia are usually described in relation to surrounding structures, and also show variation in size and general morphology. Clinically, the thoracic splanchnic nerves and celiac ganglia play a major role in pain management for upper abdominal disorders, particularly chronic pancreatitis and pancreatic cancer. Splanchnicectomy has been a treatment option since Mallet-Guy became a major proponent of the procedure in the 1940s. Splanchnic nerve dissection and thermocoagulation are two common derivatives of splanchnicectomy that are commonly used today. Celiac plexus block is also a treatment option to compliment splanchnicectomy in pain management. Endoscopic ultrasonography (EUS)-guided celiac injection and percutaneous methods of celiac plexus block have been heavily studied and are two important methods used today. For both splanchnicectomies and celiac plexus block, the innovation of ultrasonographic imaging technology has improved efficacy and accuracy of these procedures and continues to make pain management for these diseases more successful.

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“…However, serious complications occur in 1% of patients, including paraplegia as a result of the needle entering a spinal artery or piercing the dura mater, and pneumothorax as a result of piercing the diaphragm [11,12,13,14,15,16]. These complications have led to the development of an anterior approach under the guidance of transcutaneous US, CT or EUS [17,18,19,20]. However, they can be avoided through the use of EUS, which allows direct access to the CP and real-time imaging of the celiac space for CPN as well as fine needle aspiration for diagnostic purposes and tumor staging [21,22].…”

Section: Eus-guided Celiac Plexus Neurolysismentioning

confidence: 99%