• Amitabh Gulati, Jeffrey Loh, Narendra B Gutta, Paula C Ezell, Sébastien Monette, Joseph P Erinjeri, Majid Maybody, and Stephen Solomon.
• 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.
• Reg Anesth Pain Med. 2014 Jan 1; 39 (1): 26-30.

BackgroundHigh-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.MethodsTwelve 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.ResultsOn 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.ConclusionsHigh-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.

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