Percutaneous Image-Guided Cryoneurolysis

Abstract

Percutaneous image-guided cryoneurolysis is safe and effective for the management of several well-described syndromes involving neuropathic pain. Additional rigorous prospective study is warranted to further define the efficacy and specific role of these interventions.

<p>Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia</p>

“…Cryoneurolysis/cryoablation/cryoanalgesia therapy has been well described for is a well-established treatment for chronic pain states including neuropathic pain11 Recently cryoanalgesic techniques have even been applied to acute and perioperative pain states 12,13. The concept behind cryoanalgesia/neurolysis involves inducing cold temperature in the proximity of a peripheral nerve by creating ice crystals that will cause reversible axonal degeneration also known as Wallerian degeneration 5,14. The mechanism of analgesia in cryoanalgesia is multifold.…”

“…There may be reduction of conduction, activation of descending inhibitory modulation, decreased excitatory neurotransmission, generalized sodium channel blockage, and likely a combination of all of the above14 There are several advantages of cryoablative techniques over other neurolytic techniques including surgical, thermal and chemical ablation (eg, alcohol neurolysis). First, in cryoablation, the epineurium, perineurium and endoneurium are generally intact 12–14. This allows for nerve regeneration and reduced risk of neuroma as compared with other neurolytic modalities, which is especially common after surgical neural resection11 Neuroma formation can significantly worsen pre-existing pain.…”

Image-guided Sports Medicine and Musculoskeletal Tumor Interventions: A Patient-Centered Model

“…For the ablation of nerves, cryoanalgesia is preferred to avoid combustion and limit scar-related neuroma formation. [86][87][88] Osseous ablation procedures may be guided with fluoroscopy, CT, and MRI. We prefer CT and MRI guidance due to the cross-sectional visualization of the needle path and visibility of neurovascular structures.…”

Global Approach to the Patient with Pain in Interventional Radiology

“…Cryoablation affects nerves by interrupting local signal transduction, as well as through effects on systemic pain syndrome maintenance. 35 Peripheral nerves regenerate following cryoablation, following a predictable sequence of Wallerian degeneration and Schwann cell-mediated clearance of debris, cell signaling, guidance, elongation, and remyelinationat a rate of approximately 1 mm/day. 36 The implications of this regeneration include recovery of mixed motor-sensory nerves that are inadvertently or intentionally included in the cryoablation zone, as well as potential return of symptoms over time for the treated patient.…”