Cryoneurolysis

Author: Dr. Hima Bindu

What is Cryoablation?

Cyoablation is a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy some tissue. A cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas.

What is Cryoneurolysis?

When cryoablation is done to ablate a nerve to relieve pain it is called cryoneurolysis. cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in pain management.

 “Some say the world will end in fire, Some say in ice.

From what I’ve tasted of desire, I hold with those who favour fire.

But if it had to perish twice,  I think I know enough of hate

To say that for destruction Ice is also great And would suffice.”

                                                 -Robert Frost         

HISTORY OF CRYOABLATION:

Man has known the use of cold for analgesia for thousands of years. Hippocrates (460-377 BC) left us the first written records of the use of ice for pain relief, describing how snow was brought down the mountains in ancient Greece and applied to wounds for pain relief.

Modern cryoanalgesia traces its roots to Cooper who developed in 1961 a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of -1900 C. Amoils an ophthalmic surgeon, developed a simpler hand held device in 1967, which used carbon dioxide or nitrous oxide and could achieve temperature of -700C.

Lloyd coined the term ‘’cryoanalgesia’’ for its use in pain management. He proposed that this technique was superior to other methods of peripheral nerve destruction, e.g. alcohol, phenol, or surgical lesions, because it is not followed by neuritis or neuralgia.

cryoablation in scar neuralgia

What is the advantage of Cryoablation over Radiofrequency?

Cryoneurolysis is much safer way of performing neurolysis. Long term complications are less with cryoneurolysis. 

Chances of differentiation (increase of pain instead of decreasing) pain is not there in cryoneurolysis, which is an important complication of radiofrequency procedures.

Read more on cryoablation or cryoneurolysis

CRYOABLATION VS RF ABLATIONCRYOABLATIONRADIOFREQUENCY
IndicationsNeurolysis of peripheral nervesNeurolysis of peripheral nerves
Method of actionCold (-600 to -800C)Heat (+60 to +900C)
Electrode diameter1.3-4mm0.25-10mm
Treatment length120-180sec60-90sec
Lesion symmetrySymmetricAsymmetric
Introducer size12G,14G,16G, 18G, 20G, 22G16G,18G,20G,22G
Functional limitationsLarge introducers, recent probes are thinPoor neurolysis in poorly perfused areas near bone
Length of Neurolysis++++
Ease of use+++++
Availability++++
Safety+++++
Cost+++++

 

What are the clinical applications in CRANIOFACIAL PAIN?

  • Supraorbital Neuralgia
  • Infraorbital Neuralgia
  • Mandibular Neuralgia
  • Mental Neuralgia
  • Auriculotemporal Neuralgia
  • Trigeminal Neuralgia
  • Posterior Auricular Neuralgia
  • Glossopharyngeal Neuralgia

What are the clinical applications in ABDOMINAL AND PELVIC PAIN?

  • Ilioinguinal, Iliohypogastric, Genitofemoral, Subgastric Neuralgia
  • Sacral Neuralgia
  • Pudendal Neuralgia

What are the clinical applications in LOW BACK AND LOWER EXTREMITY PAIN?

  • Facet Joint Pain
  • Interspinous ligament
  • Pseudosciatica
  • Superior Gluteal Nerve
  • Sacroiliac Joint Pain
  • Cluneal Neuralgia
  • Lower Extremity Pain
  • Obturator Nerve
  • Deep Peroneal Nerve
  • Medial and Lateral Calcaneal Nerves
  • Peripheral Neuropathy

What are the clinical applications in UPPER EXTREMITY PAIN?

  • Suprascapular Nerve
  • Superficial Radial Nerve

What are the clinical applications in CHEST WALL PAIN?

It is somewhat more difficult to address post-thoracotomy neuromas, persistent pain after rib fractures, or thoracic post herpetic neuralgia, but percutaneous technique can provide excellent analgesia.

What are the Contraindications?

General contraindications to percutaneous cryoneurolysis are quite basic:

  • Bleeding diathesis
  • Infection (local or systemic)

What is the efficacy of cryoablation to control cancer pain?

Cryoablation is effective in controlling cancer pain without relevant side effects.