Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy

Area of Science:

• Neurosurgery
• Pain Management
• Oncology

Background:

• Malignant diseases frequently cause intractable pain, especially in advanced stages.
• Pain management is crucial for improving the quality of life in cancer patients.
• Cordotomy is a surgical option for unilateral malignancy-related pain.

Purpose of the Study:

• To evaluate the efficacy of computed tomography (CT)-guided percutaneous cordotomy for intractable pain.
• To assess the procedure's success rates in patients with malignancy-related pain.
• To discuss the technical aspects and outcomes of CT-guided percutaneous cordotomy over a 20-year period.

Main Methods:

• CT-guided percutaneous cordotomy targeting the lateral spinothalamic tract at the C1-C2 level.
• Procedure performed on 207 patients between 1987 and 2007, with 193 suffering from malignancy-related pain.
• Pre- and postoperative evaluation of pain scores and Karnofsky Performance Scale scores.

Main Results:

• Initial success rate of 92.5% for CT-guided percutaneous cordotomy.
• Higher success rates observed in the malignancy group.
• Selective cordotomy achieved in 83% of cancer patients, with successful bilateral procedures in 12 cases.

Conclusions:

• CT-guided cordotomy is a viable treatment option for selected cases of intractable pain in malignancy.
• The study highlights the procedure's effectiveness and provides insights from extensive clinical experience.
• Anatomic and technical details of the procedure are discussed based on a large patient cohort.