• Andrea Trescot
  • André Mansano


Cryoneuroablation is a technique of peripheral, precise neurolysis. A probe is placed on the targeted nerve, using landmarks, fluoroscopy, ultrasound, and/or built-in peripheral nerve stimulator. When the probe is in the exact right place, a gas (usually nitrous oxide) travels down the center of the probe, where it passes through a tiny opening, which causes the gas to expand and cool the tissues, creating an ice ball. These cold temperatures cause ice crystals to form in the tissues, which kill the nerves but leave the myelin sheath intact, allowing the nerve to grow back without neuroma formation.

Thus, cryoneuroablation is appropriate for the destruction of large, myelinated nerves such as the occipital, intercostal, pudendal, or superior gluteal nerves. The period of prolonged analgesia followed by return of function allows a window of rehabilitation that is unique among the neurolytic techniques.


Cryoneuroablation Cryoanalgesia Cryoneurolysis Occipital neuralgia Intercostal neuralgia Headaches Pelvic pain Pudendal neuralgia Facial pain Peripheral nerve entrapment 


  1. 1.
    Hippocrates. Heracleitus on the Universe. Aphorisms. 1931. p. 201.Google Scholar
  2. 2.
    Gruner OC. A treatise on the Canon of medicine of Avicenna. London: Luzac; 1930.Google Scholar
  3. 3.
    Evans PJ. Cryoanalgesia. The application of low temperatures to nerves to produce anaesthesia or analgesia. Anaesthesia. 1981;36:1003–13.CrossRefPubMedGoogle Scholar
  4. 4.
    Trendelenburg W. Über langdauernde nervenausschaltung mit sicherer regenerationsfähigkeit. Z Gesamte Exp Med. 1917;5:371–4.doi: 10.1007/BF03011102.CrossRefGoogle Scholar
  5. 5.
    Arnott J. Practical illustrations of the remedial efficacy of a very low or anesthetic temperature.?I. In cancer. Lancet. 1850;56:257–9. doi: 10.1016/S0140-6736(02)89874-9.CrossRefGoogle Scholar
  6. 6.
    MARCUS BIRD H, JAMES ARNOTT MD. Aberdeen. Anaesthesia. 1949;4:10–7. doi: 10.1111/j.1365-2044.1949.tb05803.x.CrossRefGoogle Scholar
  7. 7.
    COOPER IS, LEE AS. Cryostatic congelation: a system for producing a limited, controlled region of cooling or freezing of biologic tissues. J Nerv Ment Dis. 1961;133:259–63.CrossRefPubMedGoogle Scholar
  8. 8.
    RAND RW, DASHE AM, PAGLIA DE, et al. Stereotactic cryohypophysectomy. JAMA. 1964;189:255–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Green NA. Cryosurgery of the prostate gland. Ann R Coll Surg Engl. 1977;59:288–97.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Torre D. Cutaneous cryosurgery. J Cryosurg. 1968;1:202–9.Google Scholar
  11. 11.
    House WF. Cryosurgical treatment of Meniere’s disease. Arch Otolaryngol. 1966;84:616–29.CrossRefPubMedGoogle Scholar
  12. 12.
    Lewis MI, de laCruz T, Gazzaniga DA, Ball TL. Cryosurgical hemorrhoidectomy. Dis Colon Rectum. 1969;12:371–8. doi: 10.1007/BF02617751.CrossRefPubMedGoogle Scholar
  13. 13.
    Hill CL. Cryosurgical tonsillectomy. An evaluation. Arch Otolaryngol. 1968;87:434–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Lincoff HA, Mclean JM. Cryosurgery in treating retinal detachment and other eye disorders. Br J Ophthalmol. 1965;49:337–46.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Miyake K, Date H, Miyai Y, et al. Cryoanalgesia--a new approach to pain relief after thoracotomy. Kyobu Geka. 1987;40:731–5.PubMedGoogle Scholar
  16. 16.
    Rewcastle JC, Sandison GA, Saliken JC, et al. Considerations during clinical operation of two commercially available cryomachines. J Surg Oncol. 1999;71:106–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Chandler JR. Cryosurgery for recurrent carcinoma of the oral cavity. Arch Otolaryngol. 1973;97:319–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Gill W, Long WB. A critical look at cryosurgery. Int Surg. 1971;56:344–51.PubMedGoogle Scholar
  19. 19.
    Harly S, Aastrup J. Cryosurgery. Principles and application to tonsillectomy. Acta Radiol Suppl. 1972;313:253–9.PubMedGoogle Scholar
  20. 20.
    Miller D. Cryosurgery as a therapeutic modality in treatment of tumours of the head and neck. Proc R Soc Med. 1974;67:69–72.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Baust J, Chang Z. Underlying mechanisms of damage and new concepts in cryosurgical instrumentation. Paris, France: Cryosurgery Mech. Appl. International Inst. Refrigeration; 1995. p. 21–36.Google Scholar
  22. 22.
    Taylor MJ. Physico-chemical principles in low temperature biology. In: Arnold E, editor. Effects of Low Temperatures on Biological Systems. London: B.W.W. Grout and G.J. Morris; 1987. p. 3–71.Google Scholar
  23. 23.
    Mazur P. Kinetics of water loss from cells at subzero temperatures and the likelihood of intracellular freezing. J Gen Physiol. 1963;47:347–69.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Mazur P. Physical-chemical factors underlying cell injury in cryosurgical freezing physical-chemical factors underlying cell injury in cryosurgical freezing. In: Rand R, Rinfret A, von Leden H, editors. Cryosurgery. Springfield: Thomas; 1968. p. 32–51.Google Scholar
  25. 25.
    Mazur P. The role of intracellular freezing in the death of cells cooled at supraoptimal rates. Cryobiology. 1977;14:251–72. doi: 10.1016/0011-2240(77)90175-4.CrossRefPubMedGoogle Scholar
  26. 26.
    Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol. 1984;247:C125–42.PubMedGoogle Scholar
  27. 27.
    Sherman JK. Survival of higher animal cells after the formation and dissolution of intracellular ice. Anat Rec. 1962;144:171–89.CrossRefPubMedGoogle Scholar
  28. 28.
    Mundht ED. Studies on the pathogenesis of cold injury: microcirculatory changes in tissue injured by freezing. Proc Symp Artic Biol Med. 1964;4:51–72.Google Scholar
  29. 29.
    Quintanella R, Krusen F, Essex H. Studies on frostbite with special reference to treatment and the effect on minute blood vessels. Am J Physiol. 1947;149:149–61.Google Scholar
  30. 30.
    Zacarian SA, Stone D, Clater M. Effects of cryogenic temperatures on microcirculation in the golden hamster cheek pouch. Cryobiology. 1970;7:27–39.CrossRefPubMedGoogle Scholar
  31. 31.
    Tatsutani K, Rubinsky B, Onik G, Dahiya R. Effect of thermal variables on frozen human primary prostatic adenocarcinoma cells. Urology. 1996;48:441–7. doi: 10.1016/S0090-4295(96)00199-9.CrossRefPubMedGoogle Scholar
  32. 32.
    Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171–86. doi: 10.1006/cryo.1998.2115.CrossRefPubMedGoogle Scholar
  33. 33.
    Myers RR, Powell HC, Heckman HM, et al. Biophysical and pathological effects of cryogenic nerve lesion. Ann Neurol. 1981;10:478–85.CrossRefPubMedGoogle Scholar
  34. 34.
    Sunderland S. Nerves and Nerve Injuries. 2nd ed. London: Churchill Livingstone; 1978.Google Scholar
  35. 35.
    Evans PJ, Lloyd JW, Jack TM. Cryoanalgesia for intractable perineal pain. J R Soc Med. 1981;74:804–9.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Barnard D, Lloyd J, Evans J. Cryoanalgesia in the management of chronic facial pain. J Maxillofac Surg. 1981;9:101–2.CrossRefPubMedGoogle Scholar
  37. 37.
    Zakrzewska JM. Cryotherapy in the management of paroxysmal trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1987;50:485–7.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Jeong SM, Park KJ, Kang SH, et al. Anatomical consideration of the anterior and lateral cutaneous nerves in the scalp. J Korean Med Sci. 2010;25:517–22. doi: 10.3346/jkms.2010.25.4.517.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Fogaça WC, Sturtz GP, Surjan RCT, Ferreira MC. Evaluation of cutaneous sensibility on infraorbital nerve area. J Craniofac Surg. 2005;16:953–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Kazkayasi M, Ergin A, Ersoy M, et al. Microscopic anatomy of the infraorbital canal, nerve, and foramen. Otolaryngol Head Neck Surg. 2003;129:692–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Hu K-S, Kwak J, Koh K-S, et al. Topographic distribution area of the infraorbital nerve. Surg Radiol Anat. 2007;29:383–8. doi: 10.1007/s00276-007-0227-z.CrossRefPubMedGoogle Scholar
  42. 42.
    Chan BJ, Koushan K, Liszauer A, Martin J. Iatrogenic globe penetration in a case of infraorbital nerve block. Can J Ophthalmol. 2011;46:290–1. doi: 10.1016/j.jcjo.2011.05.012.CrossRefPubMedGoogle Scholar
  43. 43.
    Piagkou M, Demesticha T, Skandalakis P, Johnson EO. Functional anatomy of the mandibular nerve: consequences of nerve injury and entrapment. Clin Anat. 2011;24:143–50. doi: 10.1002/ca.21089.CrossRefPubMedGoogle Scholar
  44. 44.
    Bagheri SC, Meyer RA. Management of mandibular nerve injuries from dental implants. Atlas Oral Maxillofac Surg Clin North Am. 2011;19:47–61. doi: 10.1016/j.cxom.2010.11.004.CrossRefPubMedGoogle Scholar
  45. 45.
    Somayaji SK, Acharya SR, Mohandas KG, Venkataramana V. Anatomy and clinical applications of the mandibular nerve. Bratisl Lek Listy. 2012;113:431–40.PubMedGoogle Scholar
  46. 46.
    Scott A, Varley I. Mandibular nerve blocks. Anaesthesia. 2012;67:546. doi: 10.1111/j.1365-2044.2012.07125.x.CrossRefPubMedGoogle Scholar
  47. 47.
    Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent Update. 2010;37:350–2. 354–6, 358–60 passim.PubMedGoogle Scholar
  48. 48.
    Kemp WJ, Tubbs RS, Cohen-Gadol AA. The innervation of the scalp: a comprehensive review including anatomy, pathology, and neurosurgical correlates. Surg Neurol Int. 2011;2:178. doi: 10.4103/2152-7806.90699.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Bovim G, Bonamico L, Fredriksen TA, et al. Topographic variations in the peripheral course of the greater occipital nerve. Autopsy study with clinical correlations. Spine (Phila Pa 1976). 1991;16:475–8.CrossRefGoogle Scholar
  50. 50.
    Son B-C, Kim D-R, Lee S-W. Intractable occipital neuralgia caused by an entrapment in the semispinalis capitis. J Korean Neurosurg Soc. 2013;54:268–71. doi: 10.3340/jkns.2013.54.3.268.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Tom JA, Mesfin A, Shah MP, et al. Anatomical considerations of the suprascapular nerve in rotator cuff repairs. Anat Res Int. 2014;2014:674179. doi: 10.1155/2014/674179.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Tubbs RS, Nechtman C, D’Antoni AV, et al. Ossification of the suprascapular ligament: a risk factor for suprascapular nerve compression? Int J Shoulder Surg. 2013;7:19–22. doi: 10.4103/0973-6042.109882.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Wu Y-T, Ho C-W, Chen Y-L, et al. Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial. Anesth Analg. 2014;119:686–92. doi: 10.1213/ANE.0000000000000354.CrossRefPubMedGoogle Scholar
  54. 54.
    Chatterjee N, Roy C. Pulsed radiofrequency for the suprascapular nerve for patients with chronic headache. J Neurosurg Anesthesiol. 2014;26:267. doi: 10.1097/ANA.0000000000000009.CrossRefPubMedGoogle Scholar
  55. 55.
    Byas-Smith MG, Gulati A. Ultrasound-guided intercostal nerve cryoablation. Anesth Analg. 2006;103:1033–5. doi: 10.1213/01.ane.0000237290.68166.c2.CrossRefPubMedGoogle Scholar
  56. 56.
    Mandelkow H, Loeweneck H. The iliohypogastric and ilioinguinal nerves. Surg Radiol Anat. 1988;10:145–9. doi: 10.1007/BF02307823.CrossRefPubMedGoogle Scholar
  57. 57.
    Loos MJA, Scheltinga MRM, Roumen RMH. Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision. Ann Surg. 2008;248:880–5. doi: 10.1097/SLA.0b013e318185da2e.CrossRefPubMedGoogle Scholar
  58. 58.
    Campos NA, Chiles JH, Plunkett AR. Ultrasound-guided cryoablation of genitofemoral nerve for chronic inguinal pain. Pain Physician. 2009;12:997–1000.PubMedGoogle Scholar
  59. 59.
    Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus. 2009;26, E9. doi: 10.3171/FOC.2009.26.2.E9.CrossRefPubMedGoogle Scholar
  60. 60.
    Labat J-J, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27:306–10. doi: 10.1002/nau.20505.CrossRefPubMedGoogle Scholar
  61. 61.
    Choi S-S, Lee P-B, Kim Y-C, et al. C-arm-guided pudendal nerve block: a new technique. Int J Clin Pract. 2006;60:553–6. doi: 10.1111/j.1742-1241.2006.00836.x.CrossRefPubMedGoogle Scholar
  62. 62.
    Maigne JY, Lazareth JP, Guérin Surville H, Maigne R. The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction. An anatomical study on 37 dissections. Surg Radiol Anat. 1989;11:289–93.CrossRefPubMedGoogle Scholar
  63. 63.
    Kuniya H, Aota Y, Saito T, et al. Anatomical study of superior cluneal nerve entrapment. J Neurosurg Spine. 2013;19:76–80. doi: 10.3171/2013.4.SPINE12683.CrossRefPubMedGoogle Scholar
  64. 64.
    Horner G, Dellon AL (1994) Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res. (301):221–6.Google Scholar
  65. 65.
    Toms AD, Mandalia V, Haigh R, Hopwood B. The management of patients with painful total knee replacement. J Bone Joint Surg Br. 2009;91:143–50. doi: 10.1302/0301-620X.91B2.20995.CrossRefPubMedGoogle Scholar
  66. 66.
    Papastergiou SG, Voulgaropoulos H, Mikalef P, et al. Injuries to the infrapatellar branch(es) of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc. 2006;14:789–93. doi: 10.1007/s00167-005-0008-3.CrossRefPubMedGoogle Scholar
  67. 67.
    Detenbeck LC. Infrapatellar traumatic neuroma resulting from dashboard injury. J Bone Joint Surg Am. 1972;54:170–2.PubMedGoogle Scholar
  68. 68.
    Apaydin N, Basarir K, Loukas M, et al. Compartmental anatomy of the superficial fibular nerve with an emphasis on fascial release operations of the leg. Surg Radiol Anat. 2008;30:47–52. doi: 10.1007/s00276-007-0284-3.CrossRefPubMedGoogle Scholar
  69. 69.
    Louisia S, Masquelet AC. The medial and inferior calcaneal nerves: an anatomic study. Surg Radiol Anat. 1999;21:169–73.CrossRefPubMedGoogle Scholar
  70. 70.
    Liden B, Simmons M, Landsman AS. A retrospective analysis of 22 patients treated with percutaneous radiofrequency nerve ablation for prolonged moderate to severe heel pain associated with plantar fasciitis. J Foot Ankle Surg. 2009;48:642–7. doi: 10.1053/j.jfas.2009.05.013.CrossRefPubMedGoogle Scholar
  71. 71.
    Cione JA, Cozzarelli J, Mullin CJ. A retrospective study of radiofrequency thermal lesioning for the treatment of neuritis of the medial calcaneal nerve and its terminal branches in chronic heel pain. J Foot Ankle Surg. 2009;48:142–7. doi: 10.1053/j.jfas.2008.11.007.CrossRefPubMedGoogle Scholar
  72. 72.
    Dirim B, Resnick D, Ozenler NK. Bilateral Baxter’s neuropathy secondary to plantar fasciitis. Med Sci Monit. 2010;16:CS50–3.PubMedGoogle Scholar
  73. 73.
    Zakrzewska JM. Cryotherapy for trigeminal neuralgia: a 10 year audit. Br J Oral Maxillofac Surg. 1991;29:1–4.CrossRefPubMedGoogle Scholar
  74. 74.
    Sidebottom AJ, Carey EC, Madahar AK. Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review. Br J Oral Maxillofac Surg. 2011;49:653–6. doi: 10.1016/j.bjoms.2010.11.007.CrossRefPubMedGoogle Scholar
  75. 75.
    Momenzadeh S, Elyasi H, Valaie N, et al. Effect of cryoanalgesia on post-thoracotomy pain. Acta Med Iran. 2011;49:241–5.PubMedGoogle Scholar
  76. 76.
    Ju H, Feng Y, Yang B-X, Wang J. Comparison of epidural analgesia and intercostal nerve cryoanalgesia for post-thoracotomy pain control. Eur J Pain. 2008;12:378–84. doi: 10.1016/j.ejpain.2007.07.011.CrossRefPubMedGoogle Scholar
  77. 77.
    Green CR, de Rosayro AM, Tait AR. The role of cryoanalgesia for chronic thoracic pain: results of a long-term follow up. J Natl Med Assoc. 2002;94:716–20.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Birkenmaier C, Veihelmann A, Trouillier HH, et al. Medial branch blocks versus pericapsular blocks in selecting patients for percutaneous cryodenervation of lumbar facet joints. Reg Anesth Pain Med. 2007;32(1):27–33.CrossRefPubMedGoogle Scholar
  79. 79.
    Wolter T, Deininger M, Hubbe U, et al. Cryoneurolysis for zygapophyseal joint pain: a retrospective analysis of 117 interventions. Acta Neurochir (Wien). 2011;153:1011–9. doi: 10.1007/s00701-011-0966-9.CrossRefGoogle Scholar
  80. 80.
    Racz G, Hagstrom D. Iliohypogastric and ilioinguinal nerve entrapment: diagnosis and treatment. Pain Dig. 1992;2:43–8.Google Scholar
  81. 81.
    Glynn CJ, Carrie LE. Cryoanalgesia to relieve pain in diastasis of the symphysis pubis during pregnancy. Br Med J (Clin Res Ed). 1985;290:1946–7.CrossRefGoogle Scholar
  82. 82.
    Loev MA, Varklet VL, Wilsey BL, Ferrante FM. Cryoablation: a novel approach to neurolysis of the ganglion impar. Anesthesiology. 1998;88:1391–3.CrossRefPubMedGoogle Scholar
  83. 83.
    Hodor L, Barkal K, Hatch-Fox LD. Cryogenic denervation of the intermetatarsal space neuroma. J Foot Ankle Surg. 1997;36:311–4.CrossRefPubMedGoogle Scholar
  84. 84.
    Caporusso EF, Fallat LM, Savoy-Moore R. Cryogenic neuroablation for the treatment of lower extremity neuromas. J Foot Ankle Surg. 2002;41:286–90.CrossRefPubMedGoogle Scholar
  85. 85.
    Allen BH, Fallat LM, Schwartz SM. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. J Foot Ankle Surg. 2007;46:75–9. doi: 10.1053/j.jfas.2007.01.0062007.CrossRefPubMedGoogle Scholar
  86. 86.
    Moesker AA, Karl HW, Trescot AM. Treatment of phantom limb pain by cryoneurolysis of the amputated nerve. Pain Pract. 2014;14:52–6. doi: 10.1111/papr.12020.CrossRefPubMedGoogle Scholar
  87. 87.
    Rhame EE, DeBonet AF, Simopoulos TT. Ultrasonographic guidance and characterization of cryoanalgesic lesions in treating a case of refractory sural neuroma. Case Rep Anesthesiol. 2011. doi: 10.1155/2011/691478.PubMedPubMedCentralGoogle Scholar
  88. 88.
    Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14:180–229. doi: 10.1111/pme.12033.CrossRefPubMedGoogle Scholar
  89. 89.
    Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain – a description of techniques and review of literature. Pain Physician. 2008;11(2):215–24.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Private PracticePain and Headache CenterSt. AugustineUSA
  2. 2.Private PracticeSingular-Pain Control Center/BrazilCampinasBrazil

Personalised recommendations