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Open thoracic anterolateral cordotomy for pain relief in children: report of 2 cases
Dora Steel1, Matthew A Kirkman1, Dominic N P Thompson1
1Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom.
Insights
Open anterolateral cordotomy offers effective pain relief for children, even when not in the terminal stages of illness. This surgical procedure provides significant pain management with few side effects, expanding its potential use in pediatric care.
Area of Science:
- Neurosurgery
- Pediatric Pain Management
- Palliative Care
Background:
- Open anterolateral cordotomy is an established treatment for intractable pain in adults.
- Its application in pediatric populations is limited, with prior cases occurring only in terminally ill children.
Observation:
- This study presents two cases of pediatric patients undergoing open anterolateral cordotomy outside the immediate terminal phase of illness.
- Both patients achieved substantial pain relief.
Findings:
- Successful open anterolateral cordotomy in children not nearing death is feasible.
- Effective analgesia was achieved with minimal adverse effects in both pediatric cases.
Implications:
- Consideration of cordotomy for intractable pediatric pain should not be restricted to the end-of-life phase.
- This suggests a broader potential role for cordotomy in managing severe, refractory pain in children.
- Further research into the long-term outcomes and expanded indications for pediatric cordotomy is warranted.
Abstract:
Open anterolateral cordotomy is an effective treatment option for adults with intractable pain, but it has seldom been attempted in children. In the 2 previously reported cases in children, the procedure was used within 10 days of death from neoplastic disease. In this paper the authors describe 2 cases in which open cordotomy was used successfully in children outside the immediate terminal phase of disease. Both patients experienced effective analgesia with minimal adverse effects. The authors propose that consideration of cordotomy as an option for the management of intractable pain in children does not need to be delayed until death is imminent.
