Technical Success and Safety of Percutaneous Cryoneurolysis for Pudendal Nerve: Insights from a 328-Patient Cohort across 12 Years

Wednesday, April 2, 2025

11:51 AM – 12:00 PM CT

Location: Music City Center, 207 AB

Presenting Author(s)

HL

Hanzhou (Hanssen) Li, MD

Resident Physician
Emory University School of Medicine, United States

Author/Co-author(s)

JM

John T. Moon, MD

Resident Physician
Emory University, United States
RM

Ricardo J. Martinez Garcia, MD, MPH

Resident
Emory University School of Medicine, United States
Maxwell E. Cooper, MD

Resident-Physician
Emory University School of Medicine, United States
Junman Kim, MD

Assistant Professor
Emory University School of Medicine, United States
Junjian Huang, MD

Assistant Professor
Emory University School of Medicine, United States
J. David Prologo, MD

Division Director, Interventional Radiology
Emory University School of Medicine, United States

Purpose: Percutaneous cryoneurolysis involves exposing target nervous tissue to specific cold temperatures for calculated amounts of time over selected geographic regions for the purposes of inducing cessation of conduction, subsequent Wallerian degeneration, and predictable axonal regeneration for the purposes of managing pain related to cancer, non-neoplastic neuropathies, and post-operative damage. Drawing on our extensive experience, we aim to describe the procedural details and procedure related complications at a single large academic center during the previous 12 years.

Materials and Methods: An IRB approved retrospective review of all cryoneurolysis cases performed between Jan 2012 and August 2024 at a single quaternary care center was performed. Procedural details such as technical success, complications, and freeze-thaw cycle parameters were obtained. Technical success was defined as satisfactory placement of the probe under CT guidance, completion of the intended freeze-thaw cycles, and visualization of target inclusion directly or by measurement.

Results: A total of 328 pudendal nerve cryoneurolysis procedures were performed. 87.5% were performed with moderate sedation. No immediate complications were observed. The technical success rate was 100%. The most common freeze-thaw cycle implemented 2 cycles of 8 minute freeze and 4 minute passive thaw (20.9%). The average dose is 651.8 mGy and involved an average total service time of 45.3 minutes.

Conclusion: CT guided percutaneous cryoneurolysis of pudendal nerve is feasible and safe. Future work is required to document the durability and long-term safety of these procedures, as well as to define the optimal time-temperature function necessary to induce desired changes in the nerves.