Cryoneuroablation is an interventional technique aimed at temporary destruction of the nerve providing relief of the pain. The origin of this technique lies in the ancient time but modern cryoanalgesia traces its roots to Cooper et al.1 In 1962, they developed a device that used liquid nitrogen circulating through a hollow tube, insulated except at the tip, to achieve a tip temperature of −196,°C. Amoils,2 an ophthalmic surgeon, developed a simpler handheld device in 1967, which used high-pressure carbon dioxide or nitrous oxide and could achieve temperatures of −70°C. Lloyd et al3 coined the term “cryoanalgesia” for its use in pain management. They proposed that this technique was superior to other methods of peripheral nerve destruction, for example, alcohol, phenol, or surgical lesions, because it is not followed by neuritis or neuralgia.
The cryoneuroablation unit:
The cryoneuroablation relies on the ability of specially constructed probe to freeze tissue around it.
The cryoprobe consists of a hollow tube with a smaller inner tube.
Pressurized gas (usually N2O or CO2) at 600 to 800 psi travels down the inner tube and is released into the larger outer tube (which is at a low pressure of 10-15 psi) through a very fine aperture (0.002 mm), which allows the gas to rapidly expand into the distal tip (Figure 79-1).
The heat is extracted from the tip of the probe, resulting in temperatures as cold as −89°C at the tip itself (Joule-Thompson effect), forming an ice ball with temperatures in the range of −70°C (Figure 79-2).
The gas is then vented back to the machine itself through the outer tube and is scavenged through a ventilated outlet.
The “closed system” construction of the probe and machine ensures that no gas escapes into the patient’s tissues.
Precise gas flows are necessary for safe and effective cryoneuroablation; inadequate gas flows will not produce an ice ball, while excessive flows can cause freezing proximally up the probe, which may increase the risk of skin burns.
The probe includes a built-in nerve stimulator with sensory and motor capabilities, which allows precise localization of the target nerve (Figure 79-3).
Cryoneuroablation probe physics. (Reproduced with permission from Epimed, Farmers Branch, TX.)
Cryoneuroablation ice ball. (Reproduced with permission from Epimed, Farmers Branch, TX.)
Cryoneuroablation machine. (Used with permission from Andrea Trescot, MD.)
The mechanism of cryoneurolysis:
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessAnesthesiology Full Site: One-Year Subscription
Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more
Pay Per View: Timed Access to all of AccessAnesthesiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.