Cryoneurolysis

 Destruction of the axons of peripheral nerves can be accomplished via cryoneurolysis.  This technique uses extreme cold (minus 70-180 degrees F) to freeze nerves in an ice ball, thereby interrupting transmission along that nerve for up to 3 months.  The results of this procedure partially depend on the proximity of the cryoprobe to the nerve.

 Cryoprobes are usually powered by nitrous oxide or carbon dioxide, however the more powerful units use liquid nitrogen.  Unlike some neurodestructive techniques, this can be applied to peripheral myelinated nerves.  Cryoneurolysis lowers temperatures by expanding a compressed gas from a small chamber into a larger one at the end of the probe.  Time to create a lesion of the nerve is about 90 seconds for small nerves while several such lesions are produced on larger nerves.  A small skin incision is usually required.

Cryoneurolysis is best suited for discrete lesions such as well defined small regions of consistent pain and consistent myofascial trigger points, or in locations in which the peripheral nerve can be located through peripheral stimulation via needle.

 It is possible to electrically stimulate through the probe itself on some units.

Cryoneurolysis can be used on pudendal nerves, intercostal nerves, facet medial branches, sural nerves, lateral femoral cutaneous nerves, etc.

Post lesioning dysesthesia (occasional burning pain) is rare as opposed to chemoneurolysis (use of chemicals to destroy nerves) or radiofrequency neurolysis and the procedure can be repeated as often as is indicated.  Of course regardless of the method of nerve destruction, the nerves will regrow again eventually.

 

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