Tellem R, et al. - In this study, researchers sought to present their experience in interdisciplinary evaluation of cancer patients undergoing neurosurgical interventions for intractable pain. They also reviewed clinical considerations guiding the choice of the therapeutic approach through representative clinical cases. They suggest that neurosurgical procedures could produce significant pain relief in carefully selected patients, evaluated by an interdisciplinary palliative care team.

Methods

• All patients who were evaluated and operated for intractable oncological pain were retrospectively reviewed.

Results

• Researchers evaluated 89 patients.
• Neurosurgical interventions were selected for 41 patients.
• They excluded 48 patients; the reason for exclusion was patients' refusal in 22 case, and 26 patients were observed to be clinically unsuitable for these interventions.
• Selective cordotomy was performed on 23 patients with localized pain.
• They noted that good pain palliation was achieved in 21 patients immediately post op (91%), at 30 days post op 17 patients were still pain free (74%), and at 3-months 6/6 patients available for follow-up were still free of their original pain.
• Bilateral stereotactic cingulotomy was performed on 16 patients with diffuse pain.
• All patients showed good pain palliation in the immediate post op period.
• During the 1-month and 3-months follow-up visits, significant pain relief was reported by 12/13 patients (92%) and 7/9 patients (77%) available for follow-up.
• Midline myelotomy was perormed in 2 patients with abdominal pain.