Therapeutic Approach to the Pancoast Pain Syndrome

Esposito, Stefano; Bruni, Piero Giovanni; Delitala, Alberto; Canova, A.; Hernández, R Sánchez; Callovini, Gemma

doi:10.1159/000101138

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…In the report by Loeser [10], the initial success rate was 54%, and the long-term success rate 43%, in 13 cancer pain patients. Esposito et al [8] reported their experience of cordotomy and selective posterior rhizotomy in 20 cases of the Pancoast syndrome, and posterior rhizotomy was effective in 14 of 16 patients at the 6-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Dorsal rhizotomy, first reported by Abbe [6] in 1911, involves sectioning of the posterior sensory rootlets and has been reported to have a role in patients in whom the specific dermatomal level can be identified [1,7,8,9,10,11,12,13,14,15,16]. According to a recent, detailed review of neuroablative treatment for cancer pain by Raslan et al [17], only cordotomy had some evidence of an effect among destructive procedures for cancer pain, and dorsal rhizotomy was said to have been abandoned for the open nature of its procedure, the fading effect and the presence of more effective procedures.…”

Section: Introductionmentioning

confidence: 99%

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Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Son

Yoon²,

Kim

et al. 2014

Stereotact Funct Neurosurg

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Background: Pain from neoplastic lumbosacral plexopathy is resistant to conventional pain treatment. According to a recent review of destructive procedures for cancer pain, only cordotomy has been reported to play an important role in the treatment of cancer pain. To date, the effectiveness of dorsal rhizotomy, which selectively interrupts pain transmission, has not been shown in neoplastic lumbosacral plexopathy. Objectives: The present study seeks to find out the effectiveness of selective dorsal rhizotomies for intractable pain from neoplastic lumbosacral plexopathy in terminal pelvic cancer patients. Methods: Dorsal rhizotomies of the involved segments were performed on 6 cancer patients in whom neuropathic pain from lumbosacral plexus involvement in terminal pelvic cancer had been refractory to other therapies. Clinical efficacy of the procedure was assessed by comparing patient pain ratings and narcotic usage before and after dorsal rhizotomy. Results: Examination of the results indicated a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed and no recurrence of pain from neoplastic lumbosacral plexopathy was noted. Conclusions: These findings provide corroborating clinical evidence for the effectiveness of selective dorsal root rhizotomy for the intractable pain from lumbosacral plexopathy in terminal pelvic cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Son

Yoon²,

Kim

et al. 2014

Stereotact Funct Neurosurg

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“…6 The operation involves the percutaneous insertion of an electrode through the cheek into the trigeminal nerve within Meckel's cave through the foramen ovale. [8][9][10][11][12][13] The use of this procedure for treating cancerrelated orofacial pain has not been reported in decades. The deliberately damaged nerve is then no longer able to transmit nociceptive signals.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Trigeminal Rhizotomy for Facial Pain Secondary to Head and Neck Malignancy

Mendelsohn

Ranjan²,

Hawley³

et al. 2013

The Clinical Journal of Pain

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“…Techniques to interrupt pain pathways include multiple modalities 10 such as cervical cordotomy, 11,12 selective posterior rhizotomy/radiculotomy, 3 stereotactic thalamotomy, commissural myelotomy, and radiofrequency ablation; cervical epidural analgesia, 9 central administration of opiates, 3 and brachial plexus block 13,14 …”

Section: Discussionmentioning

confidence: 99%

“…Options for treating intractable pain in these patients include radiculotomy, cordotomy, and neuraxial administration of opiates. Selective posterior radiculotomy results in better pain relief than the latter 2 techniques 3 . Radiofrequency lesioning of the dorsal root ganglion can interrupt pain pathways in patients with intractable pain originating in the cervical nerve roots 4 .…”

Section: Introductionmentioning

confidence: 99%

Alleviation of Pancoast's Tumor Pain by Ultrasound‐Guided Percutaneous Ablation of Cervical Nerve Roots

Bhatia

2008

Pain Practice

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The case report describes use of real-time ultrasound guidance to facilitate percutaneous ablation of cervical nerve roots in a patient with Pancoast's syndrome. Distortion of anatomy by the tumor made it difficult to perform the procedure safely using fluoroscopy. A 64-year-old right-handed male patient with carcinoma of the left lung presented with severe pain in the left shoulder and the arm. A clinical diagnosis of the left brachial plexopathy secondary to tumor involvement of C5 to C8 nerve roots was made. Radiological appearance of the cervical spine revealed distorted anatomy because of severe degeneration of the cervical spine and guarding torticollis. Diagnostic prognostic block of the C4 to C7 exiting nerve roots was done under ultrasound guidance and resulted in more than 75% reduction in pain intensity for 4 hours. Ultrasound-guided percutaneous cervical rhizotomy was performed later. At 3-month follow-up, the patient still had complete pain relief as well as improvement in quality of sleep. Ultrasound-guided cervical nerve roots ablation is a feasible approach for patients with intractable neuropathic pain secondary to Pancoast's tumor. It can be a useful alternative to fluoroscopy in patients in whom a fluoroscopy-guided approach is deemed difficult and hazardous.

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Therapeutic Approach to the Pancoast Pain Syndrome

Cited by 4 publications

References 8 publications

Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Percutaneous Trigeminal Rhizotomy for Facial Pain Secondary to Head and Neck Malignancy

Alleviation of Pancoast's Tumor Pain by Ultrasound‐Guided Percutaneous Ablation of Cervical Nerve Roots

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