title: Novel use of noninvasive high-intensity focused ultrasonography for intercostal nerve neurolysis in a swine model.
abstract: BACKGROUND
  High-intensity focused ultrasound (HIFU) is a noninvasive thermal ablation technique. High-intensity focused ultrasound has been used in small-animal models to lesion neural tissue selectively. This study aimed to evaluate the efficacy of HIFU in a large-animal model for ablation of nerves similar in size to human nerves.
  
  
  METHODS
  Twelve acute magnetic resonance-guided HIFU ablation lesions were created in intercostal nerves in a swine model. In a second pig, as a control, 4 radiofrequency ablation and 4 alcohol lesions were performed on intercostal nerves under ultrasound guidance. Preprocedural and postprocedural magnetic resonance imaging was then performed to evaluate radiologically the lesion size created by HIFU. Animals were euthanized 1 hour postprocedure, and necropsy was performed to collect tissue samples for histopathologic analysis.
  
  
  RESULTS
  On gross and histological examination of the intercostal nerve, acute HIFU nerve lesions showed evidence of well-demarcated, acute, focally extensive thermal necrosis. Four intercostal nerves ablated with HIFU were sent for histopathologic analysis, with 2 of 4 lesions showing pathologic damage to the intercostal nerve. Similar results were shown with radiofrequency ablation technique, whereas the intercostal nerves appeared histologically intact with alcohol ablation.
  
  
  CONCLUSIONS
  High-intensity focused ultrasound may be used as a noninvasive neurolytic technique in swine. High-intensity focused ultrasound may have potential as a neuroablation technique for patients with chronic and cancer pain.
authors: From the *Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; †Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; ‡Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; §Department of Comparative Medicine, Medical University of South Carolina, Charleston, SC; and ∥Center of Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Amitabh
authors: A
authors: Gulati
authors: Jeffrey
authors: J
authors: Loh
authors: Narendra B
authors: NB
authors: Gutta
authors: Paula C
authors: PC
authors: Ezell
authors: Sébastien
authors: S
authors: Monette
authors: Joseph P
authors: JP
authors: Erinjeri
authors: Majid
authors: M
authors: Maybody
authors: Stephen
authors: S
authors: Solomon
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000379:methods; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D007367:Intercostal Nerves / Q000502:physiology / Q000601:surgery*; D023421:Models, Animal; D009407:Nerve Block / Q000379:methods*; D013552:Swine