Extracranial Procedures & Ablative Neurosurgical Techniques for Control of Cancer Pain

Abstract

Cancer pain is under-treated worldwide, although up to 25% of patients with cancer die with unresolved pain. Spinal cord pain pathways are the primary target for the surgical management of cancer pain. The most common procedures that are done at the spinal cord level are cordotomy, trigeminal tractotomy and myelotomy. Open approaches to these targets are more or less obsolete, and they are mostly done through the percutaneous route, the image guidance used to be the method of imaging; in the present series we used the CT as a new primary method of guidance.

51 patients were treated with either one of the three procedures, 38 treated with cordotomy, 8 treated with trigeminal tractotomy and 5 treated with extraleminiscal myelotomy. All patients undergone percutaneous CT guided radiofrequency ablation of one of the three pathways targeted. 98% of the patients had satisfactory pain relief up to 6 month follow up.