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Published on: February 23, 2015
Awake Percutaneous Cervical Cordotomy in Patients With Cancer: A Technical Report
Adinda P Pradhana1, Hans Timmerman1, Egbert J M Klarenbeek1
1Department of Anesthesiology, Pain Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Background:
Percutaneous cervical cordotomy (PCC) is a minimally invasive radiofrequency procedure for intractable unilateral cancer pain. Commonly performed under conscious sedation, awake PCC enables real-time patient feedback, potentially improving targeting precision and expanding eligibility for patients in whom sedation poses risks.
Method And Technique:
This article presents the structured protocol for awake PCC implemented at our center, including pre-procedural training, positioning, fluoroscopic guidance, impedance monitoring, sensory and motoric testing, lesioning strategy, and aftercare. The key principle is to create the smallest effective lesion, applied incrementally until spinothalamic tract disruption is confirmed.
Discussion:
In our experience, awake PCC enables precise targeting and has yielded up to 90% success in pain relief. The approach requires substantial preparation, including training for both patient and team to ensure cooperation, clear communication, and tolerance of brief intraoperative discomfort. Although these demands can be challenging, we have found awake PCC to be a safe and effective last-resort option for patients facing devastating pain.
Conclusion:
This technical note provides a practical and stepwise approach to awake PCC. It may assist clinicians in adopting or refining the technique.
