Cryoneurolysis Literature Support Surg Endosc. 2003 Feb;17(2):196-200. Epub 2002 Dec 04. Cryoanalgesic ablation for the treatment of chronic postherniorrhaphyneuropathic pain. Fanelli RD, DiSiena MR, Lui FY, Gersin KS.Berkshire Medical Center Department of Surgery, Pittsfield, MA 01201, USA.rfanemd@massmed.org BACKGROUND: Chronic postoperative pain has been reported in as many as 62.9% of patients after inguinal herniorrhaphy. Moderate to severe neuropathic pain requiring intervention develops in 2.2% to 11.9% of patients as a result of ileoinguinal and genitofemoral nerve entrapment. Cryoanalgesic ablation has been successful in treating chronic pain from craniofacial neuralgia, facet joint syndrome, and malignant pain syndromes. We report our experience using cryoanalgesic ablation for chronic ileoinguinal and genitofemoralneuralgia after inguinal herniorrhaphy. METHODS: Ten patients with ileoinguinal, genitofemoral, or combined neuralgia underwent 12 cryoanalgesic ablations between April 1996 and June 2001. These patients were referred from a multidisciplinary pain clinic, and focused low-volume nerve blocks were used to map nerve involvement preoperatively. After surgical exposure, nerves and surrounding tissues were cooled to ?70 degrees C for 3 min using the Lloyd Neurostat. Patients were seen 2 weeks postoperatively and offered monthly follow-up assessments. RESULTS: Nine men and one woman, ages 20 to 54 (mean, 42.6 years) were treated during 58 months, with a mean follow-up period of 8.2 months, for ileoinguinal (n = 4), genitofemoral (n = 1), and combined (n = 5) neuralgia. Patients reported one to five prior herniorrhaphies (mean, 1.8), experienced neuropathic pain 0 to 14 years (mean, 6.3 years), and underwent up to 3 (mean, 1.3) ablative pain procedures before referral. After cryotherapy, patients reported overall pain reduction of 0% to 100% (mean, 77.5%; median, 100%); 80% reported decreased analgesic use, and 90% reported increased physical capacity. Two patients underwent additional cryotherapy, one for incomplete relief and one for recurrent pain, both with 100% efficacy. Wound infection (n = 1) was the only complication. CONCLUSIONS: Cryoanalgesic ablation successfully eliminates ileoinguinal and genitofemoral neuralgia in most patients, and should be considered early in the treatment of patients with postherniorrhaphy neuropathic pain. Br J Oral Maxillofac Surg. 2002 Jun;40(3):244-7. Cryosurgical treatment of genuine trigeminal neuralgia. Pradel W, Hlawitschka M, Eckelt U, Herzog R, Koch K.Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Dresden, Germany. winnie.pradel@mailbox.tu-dresden.de A newly developed cryoprobe for peripheral nerves allows surgeons to freeze branches of the trigeminal nerve at the infraorbital or the mandibular foramen without exposing the nerve or damaging the surrounding tissue. The probe has an outer diameter of 2.7mm, and a vacuum-insulated shaft to protect the adjacent tissue. It is designed to be inserted transmucosally. The cryoprobe was used in 19 patients to freeze the infraorbital nerve or the inferior alveolar nerve. At 4-8 months after cryotherapy sensation in the areas innervated by the treated nerve had returned, but pain was absent for at least 6 months. The pain recurred in 13 out of 19 patients within 6-12 months. However, it was possible to repeat the cryotherapy as the procedure was not stressful. Cryosurgery widens the range of methods available to treat trigeminal neuralgia. Copyright 2002 The British Association of Oral and Maxillofacial Surgeons. Singapore Dent J. 2000 Dec;23(1 Suppl):49-55. Cryotherapy in the management of trigeminal neuralgia: a review of the literature and report of three cases. Poon CY. Dept of Oral and Maxillofacial Surgery, National Dental Centre, 5 Second Hospital Ave Singapore168938. Trigeminal neuralgia is a unique neuropathic syndrome confined to the trigeminal system with no analog in the somatic dermatomes or the other cranial nerves. Medical treatment remains the first line of treatment with carbamezapine as the drug of choice. Surgery, central or peripheral is indicated then medical treatment fails or its side effects diminishes quality of life. No surgery offers a permanent cure. Recurrence rates are highest in the most peripheral techniques but these also have the lowest morbidity. Cryotherapy produces a reliable, prolonged and reversible nerve block with no aggravation of symptoms. It is a simple and repeatable procedure in patients who want to avoid major surgery or where it is contra-indicated. Acta Stomatol Belg. 1993 Jun;90(2):87-93. The value of cryotherapy in the management of trigeminal neuralgia. De Coster D, Bossuyt M, Fossion E.Department of Oral, Maxillo-Facial and Head and Neck Surgery, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Faculty of Medicine, Catholic University, Leuven. Cryotherapy to 32 individual branches of the trigeminal nerve in 27 patients, who were followed up for 3 years, resulted in pain relief out-lasting return of sensation. After one year 65% of patients were pain free. In the treatment of trigeminal neuralgia, cryotherapy is an easy method with similar results but lower complication rate in comparison with other peripheral methods. There are many many articles on the use of cryoablation for tumor therapy, destroying nerves inside the heart, the brain, and bone, kidneys, and liver.