Ct-guided high level percutaneous cervical cordotomy for intractable cancer pain

Bekâr, Ahmet; Taşkapılıoğlu, Mevlüt Özgür; Ocak, Pınar Eser; Bilgin, Hülya

doi:10.5137/1019-5149.jtn.14558-15.1

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…As mentioned earlier the distance between the skin and dura as well as the anteroposterior and lateral cord diameters are measured for every patient before starting the ablative procedure as these diameters exhibit great individual variations [7, 15]. For example, the anteroposterior diameter of the cord was reported to range from 7.0 to 12.8 mm and the transverse diameter from 9.3 to 14 mm at the occiput-C1 level in Kanpolat et al’s series [1, 16].…”

Section: Discussionmentioning

confidence: 99%

CT-Guided Percutaneous Trigeminal Tractotomy-Nucleotomy for Intractable Craniofacial Pain

Bekâr

Ocak

Taşkapılıoğlu

et al. 2020

Stereotact Funct Neurosurg

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Object: In this report, we aimed to analyze the outcome results of our patients who underwent percutaneous trigeminal tractotomy (TR) and nucleotomy (NC) procedures, which are defined as destructive procedures targeting the descending trigeminal tractus and nucleus caudalis of the spinal trigeminal nucleus, respectively, for intractable craniofacial pain. Methods: The medical records of a total of 12 patients who underwent a total of 14 computed tomography (CT)-guided TR-NC procedures at our clinics between 2005 and 2017 were retrospectively reviewed. Results: A significant increase in patients' performance status (p = 0.015) as well as a significant decrease in the VAS score (p < 0.001) were achieved. Grade I pain relief (VAS = 0, no pain) was established in 66.7% of the patients, whereas grade II pain relief was observed in the remaining patients. Two of the patients suffered from recurrent pain after the initial procedure. Both patients underwent a second trigeminal TR-NC procedure, and grade I pain relief was re-established. The mean VAS score at 3-month follow-up was 1.4 ± 1.1, whereas this score at 6-month follow-up was 2 ± 1.3. The trigeminal TR-NC procedure resulted in a significant decrease in patients' VAS scores at 3-and 6-month follow-up visits compared with preoperative VAS scores (p < 0.001). Transient ataxia was noted in only one patient (8.3%) early after the procedure. Conclusions: The results presented in the current study support the efficacy of the percutaneous CT-guided trigeminal TR-NC procedure in the management of intractable facial pain in selected patients. The use of CT guidance allows direct visualization of the target area, thereby enhancing the safety and success of the procedure.

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Section: Discussionmentioning

confidence: 99%

CT-Guided Percutaneous Trigeminal Tractotomy-Nucleotomy for Intractable Craniofacial Pain

Bekâr

Ocak

Taşkapılıoğlu

et al. 2020

Stereotact Funct Neurosurg

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“…The procedure has been described, with minor variations, in many articles and textbooks 5,30,35–39 . Imaging during PCC for electrode positioning can be done with C‐arm fluoroscopy, computed tomography, 18,40–42,43 O‐arm‐guided navigation, 26 or endoscopy 33,44 …”

Section: Methodsmentioning

confidence: 99%

“…In a relatively small group of patients with strict unilateral cancer pain below C5, which is unresponsive to more conventional therapies, percutaneous cervical cordotomy (PCC) appears to be an effective pain treatment with minor side effects 7–15 . Serious side effects and complications are minimal in experienced hands 16–22 …”

Section: Introductionmentioning

confidence: 99%

Percutaneous Cervical Cordotomy for the Treatment of Cancer Pain: A Prospective Case Series of 52 Patients with a Long‐Term Follow‐Up

et al. 2021

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Aim The aim of this study is to describe the effects of percutaneous cervical cordotomy (PCC) on pain, opioid consumption, adverse events, and satisfaction in palliative care patients with cancer pain after PCC until end of life. Methods This is a prospective observational case series of 58 PCCs in 52 consecutive patients. Indication for PCC was unilateral cancer pain with a maximum numeric rating scale (NRS) of pain above 5 despite maximal conservative treatment. The PCC was fluoroscopy guided. A radiofrequency lesion was made at 95°C for 20 seconds. The pain location and pain scores, analgesic medication, the cranial and caudal borders of dermatomes hypoesthetic for pin pricks, dysesthesia, urinary retention, Horner’s syndrome, muscle strength, Karnofsky performance scale (KPS) score, patient satisfaction, hospital anxiety and distress score (HADS), and RAND 36 score were evaluated at 1 day; 1 and 6 weeks; and 3, 6, 9, 12 18, and 24 months after PCC, or until death if death occurred during the follow‐up period. Results Pain relief after PCC was intense (change in median maximum NRS from 9 to 0) and persistent. Median opioid use per day was 240 mg (145 to 565 mg) before PCC and 55 mg (0 to 120 mg) after PCC. The upper and lower borders of dermatomes hypoesthetic for pin pricks were stable over time. The most common side effects were short‐term (< 1 week) neck pain (28%), dysesthesia (40%), and mild loss of muscle strength (11%). Approximately 83% of the patients were satisfied or very satisfied with the results of PCC 1 week after the procedure, and this percentage remained high in the long term. There was no significant change in the KPS score, HADS, and RAND 36 score. Conclusion Percutaneous cervical cordotomy is an effective treatment for unilateral cancer pain. The reduction in pain, reduction in opioid consumption, and hypoesthetic area remain stable until death.

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“…Percutaneous cordotomy with computed tomography (CT) guidance is safer than the open cordotomy of the 1950s. 10,11,12,13,14 Magnetic resonance imaging (MRI) guidance, together with intraoperative neurophysiological testing, increases accuracy of deep-brain stimulation targeting to a fraction of a millimeter. 15 Advancement from a single-contact electrode to 32-contact electrodes provides countless options for stimulation paradigms in cases of spinal cord stimulation.…”

Section: Introductionmentioning

confidence: 99%

Revisiting the WHO Analgesic Ladder for Surgical Management of Pain

McGuire

Slavin

2020

AMA Journal of Ethics

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The opioid epidemic challenges current attitudes toward pain management and necessitates the reexamination of the World Health Organization (WHO) 3-step analgesic ladder, introduced in 1986 for cancer pain management. Surgical treatment of pain is a logical extension of the original guideline, which is often absent in conversations with patients about treatment options for their pain and consequentially underutilized. However, with concerns growing regarding opioid use, a shift in the stepwise approach of the WHO analgesic ladder in an age of developing technology and surgical offerings could have profound implications for patients and public health. Surgical interventions potentially provide a long-term, cost-effective management strategy to reduce opioid use. This review canvasses surgical options, highlights literature on failed back surgery syndrome and spinal cord stimulation and reconsiders the current ladder approach to pain management. To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .

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Ct-guided high level percutaneous cervical cordotomy for intractable cancer pain

Abstract: ABSTRACTto 55 to 95% in later stages (20). The procedure is generally useful for unilateral nociceptive pain.

Cited by 3 publications

References 21 publications

CT-Guided Percutaneous Trigeminal Tractotomy-Nucleotomy for Intractable Craniofacial Pain

CT-Guided Percutaneous Trigeminal Tractotomy-Nucleotomy for Intractable Craniofacial Pain

Percutaneous Cervical Cordotomy for the Treatment of Cancer Pain: A Prospective Case Series of 52 Patients with a Long‐Term Follow‐Up

Revisiting the WHO Analgesic Ladder for Surgical Management of Pain

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