Cordotomy in mesothelioma-related pain: a systematic review

France, Barbara D; Lewis, Ruth; Sharma, Manohar; Poolman, Marlise

doi:10.1136/bmjspcare-2013-000508

Cited by 36 publications

(23 citation statements)

References 24 publications

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“…This is a rare complication and we did not find another report of it in the literature. However, the reported rate of hemiparesis due to cord injury following cordotomy is between 0 and 5% [7,8,9,11,13,14,15]. Cervical contrast injection is commonly used, especially when the procedure is done under fluoroscopy only, due to the need to demonstrate the landmarks used for targeting (i.e., the anterior surface of the cord and dentate ligament) [9].…”

Section: Discussionmentioning

confidence: 99%

O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Strauss

Berger²,

Arad

et al. 2017

Stereotact Funct Neurosurg

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Background: Pain is often one of the most debilitating symptoms in patients with advanced oncological disease. Patients with localized pain due to malignancy refractory to medical treatment can benefit from selective percutaneous cordotomy that disconnects the ascending pain fibers in the spinothalamic tract. Objectives: Over the past year, we have been performing percutaneous radiofrequency cordotomy with the use of the O-Arm intraoperative imaging system that allows both 2D fluoroscopy and 3D reconstructed computerized tomography imaging. We present our experience using this technique, focusing on technical nuances and complications. Methods: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy between March 2016 and March 2017. Results: Nineteen patients underwent percutaneous cordotomy procedures. Two patients developed intraoperative delirium and were unable to tolerate the procedure. In 16 out of 17 completed procedures, we achieved excellent immediate pain relief (94%). At 1 month after operation, 15 of the 17 (88%) patients were pain free, and at 3 months 5 out of 5 patients available for follow-up were still free of their original pain. Mirror pain developed in 6 of the 17 patients (35%), but was mild in 4 of these cases and controlled with medications. We experienced 1 serious complication (6%) of ipsilateral hemiparesis. Conclusion: Percutaneous cordotomy using the O-Arm is safe and effective in the treatment of intractable oncological pain.

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Section: Discussionmentioning

confidence: 99%

O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Strauss

Berger²,

Arad

et al. 2017

Stereotact Funct Neurosurg

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“…In addition, percutaneous cervical cordotomy (PCC) has little role in the treatment of midline perineal pain, should be performed bilaterally under CT guidance, and has considerable morbidity and mortality (22,23). Besides their potential for serious side effects, modalities such as intrathecal pumps and neuromodulation are expensive and require close surveillance with protracted after-care making their use impractical in developing countries (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique of Saddle Rhizotomy Using Thermal Radiofrequency for Intractable Perineal Pain in Pelvic Malignancy: A Pilot Study

et al. 2018

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Background: The prevalence of pain in advanced pelvic cancer may reach up to 95%. Control of such pain is often difficult owing to a variety of neuroanatomical and functional peculiarities. Different modalities have been utilized to treat this pain including saddle chemical rhizolysis with the potential for jeopardizing the neural control of the sphincters. Objective: The aim of this pilot study is to determine the feasibility of using selective thermal radiofrequency as an alternative to saddle chemical rhizolysis in patients with refractory perineal pain associated with pelvic malignancies. Study Design: Pilot study. Setting: Pain Relief Department of the National Cancer Institute, Cairo University. Methods: Forty patients, 18 years of age or older, who had pelvic malignancy and were complaining of moderate or severe perineal pain not controlled with maximum tolerable doses of morphine sulfate for at least 4 weeks were randomly allocated to receive selective saddle rhizotomy using thermal radiofrequency ablation of S3 on one side and bilateral ablation of S4 and S5 (RF group, n = 20) or conventional chemical rhizotomy using hyperbaric 6% phenol in glycerin (Phenol group, n = 20). Patients were assessed for the intensity of pain, daily consumption of analgesics, functional improvement, overall patient satisfaction, degree of disability and occurrence of procedure-related side effects at 1,4, and 12 weeks. Result: The results were comparable in both groups regarding the control of pain and functional improvement. The incidence of specific procedure-related adverse outcomes was also equivalent for both interventions, although per-patient incidence of major complications was significantly higher in the phenol group. Limitation: Small sample size to demonstrate statistical significance of the relatively small frequency of events, and the patients could not be blinded to the intervention they received owing to the technical uniqueness of either intervention. Conclusion: Selective thermal radiofrequency ablation of the S3 root on one side, S4 root on both sides, and S5 roots could serve as a feasible alternative to conventional saddle rhizotomy using hyperbaric phenol. Key Words: Perineal cancer pain, chemical rhizotomy, thermal radiofrequency

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“…For intractable pain not response to the above therapies (or intrathecal drug delivery is not indicated), both percutaneous cervical cordotomy and dorsal root entry zone (DREZ) procedure may be considered. Cordotomy has been reported to be effective in patients suffering from mesothelioma, and DREZ has been efficacious for pain related to Pancoast tumors [31,32].…”

Section: Discussionmentioning

confidence: 99%