Minimizing nerve injury with Celiac Plexus Neurolysis?

[huskydoc]

Doing a CT guided Celiac neurolysis soon for Pancreatic CA patient
Read through the various threads on Celiacs on SDN.

I wanted to poll some of the readers in order to gauge best approach/best outcome etc.

I am planning to use EtOH given we are using CT and both literature and opinions here describing good benefit with EtOH over Phenol

Questions?
1. Do folks do anterocrural or retro-crural (retroaortic)? I realize most are using fluoro.

2. If performing retrocrural, how do you reduce or avoid lumbar nerve injury from neurolytic agent spread?

My plan was to go anterocrural (celiac) but both reports and posters on here seem to go after the thoracic splanchnics (retrocrural). The latter technique is concerning for iatrogenic nerve injury, so any tips or thoughts are much appreciated.

thanks

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[lobelsteve]

I send to IR for CT neurolysis. They go anterior to the crura.

 

[lovebailey2001]

I personally like and do Trans aortic NCPB with lower amount of ETOH (15 ml. total) ie ante crural under fluoroscopy. No incidence of nerve injury till now, have done abt 25-30.
In past, I have done retro crural also form both sides and think prone position for 20-30 mins post operatively helps to keep alcohal away from the nerves.
For splanchnics, I like to do RFA rather than neurolytics.