Percutaneous Neurolysis

Neurolysis may involve temporary or long-lasting disruption of nerves using chemical agents, thermal energy, or cold-based techniques. As specialists in imaging, and imaging guidance, Interventional radiologists perform these procedures under imaging guidance (CT, fluoroscopy, or ultrasound) to maximise precision and safety.

Targets for percutaneous neurolysis vary depending on the pain location and include:

•    Coeliac and splanchnic nerves – upper abdominal pain from pancreatic, gastric, or hepatic malignancy.
•    Lumbar plexus, hypogastric plexus, and ganglion impar – pelvic pain from gynecologic, urologic, rectal, or retroperitoneal tumors.
•    Stellate ganglion and thoracic sympathetic chain – cervicothoracic, upper limb, and chest wall pain.

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Techniques of Percutaneous Neurolysis

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Chemical Neurolysis
Chemical neurolysis involves the injection of neurolytic agents such as alcohol to destroy targeted nerve fibers. This is often performed following a “test” procedure with (reversible) local anaesthetic only. 

Applications:

• Coeliac, splanchnic, hypogastric plexus, lumbar plexus, ganglion impar, stellate, and thoracic sympathetic blocks

• Used when long-term pain relief is needed in malignancy

Benefits:

• Can provide durable pain control lasting months to years

• Reduces the need for systemic opioids

• Can be tailored to specific pain distributions

Considerations:

• May cause temporary numbness or weakness in the target area

• Risk of inadvertent injury to adjacent structures; precise imaging guidance is essential

 

Radiofrequency (RF) Neurolysis / Neuromodulation
Radiofrequency neurolysis uses high-frequency electrical energy delivered via a needle electrode to ablate or modulate nerve function.

Applications:

• Coeliac, splanchnic, lumbar plexus, hypogastric plexus, ganglion impar, stellate, and thoracic sympathetic chains

• Can be performed as:

  • Thermal ablation for neurolytic effect

  • Pulsed RF for neuromodulation without complete nerve destruction

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Benefits:

• Offers precise, controlled ablation of pain pathways

• Pulsed RF may reduce pain while minimizing sensory or motor loss

• Often used for patients with cancer-related pain refractory to medications

Considerations:

• Requires skilled imaging guidance to avoid injury to vessels, organs, or spinal nerves

• Pain relief may last weeks to months; repeat procedures can be performed if needed

 

Cryoneurolysis
Cryoneurolysis uses extreme cold delivered via a needle probe to temporarily disrupt nerve conduction.

Applications:

• Selected plexus and sympathetic nerve targets, particularly for neuropathic or malignant pain

Benefits:

• Can provide effective short to mid term, repeatable pain relief

• Minimal systemic effects

• Nerve regeneration over time allows reversible effects, improving safety profile as compared with ablative techniques

Considerations:

• Temporary numbness or weakness is expected

• Requires precise imaging and careful patient monitoring

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Safety and Considerations

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All percutaneous neurolysis procedures are generally safe when performed by experienced interventional radiologists. Potential risks include bleeding, infection, nerve injury, hypotension, or transient motor/sensory deficits depending on the target. Patient selection is essential, and these procedures are usually performed in close collaboration with oncology, palliative care, and anaesthesia teams to ensure optimal outcomes and tailored pain management.

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Preparation and Referral

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Specialist IR accepts referrals for specialised pain management procedures following multidisciplinary consultation as above. If you would like to refer to an Interventional Radiologist for consideration of nerve block, or percutaneous neurolysis, please send a referral for consultation, including the following; 
•    Recent cross sectional imaging
•    Relevant blood test results 
•    Records of recent consultation(s) with other specialists

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Neurolysis procedures are performed at most of our public and private hospital locations in Melbourne, Victoria, Australia. 

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Neurolysis content by Dr James Lisik.