Neuroablative Procedures for Patients With Cancer Pain
Unilateral Somatic Nociceptive/Neuropathic Body Cancer Pain
Rhizotomy
Rhizotomy, both in its percutaneous radiofrequency (RF)/chemical and open surgical forms may be used to treat patients with unilateral body cancer pain and occasionally bilateral cancer pain, but outcomes such as sensory deficit (as a result of rhizotomy) and occasionally a motor or autonomic deficit (depending on the nerve(s) ablated) should be considered.
(III)Dorsal root entry zone (DREZ)
There is insufficient data to make recommendations regarding the efficacy of DREZ for unilateral body cancer pain.
()Thalamotomy
Mediodorsal and basal thalamotomy (RF or radiosurical) may be used to treat patients with unilateral somatic nociceptive/neuropathic body cancer pain. Potential complications such as transient diplopia, confusion, or delirium should be considered.
(III)Mesencephalotomy
Mesencephalotomy may be used to treat patients with unilateral somatic nociceptive/neuropathic body cancer pain, especially as an alternative to cordotomy when pain involves dermatomes above C5. Potential complications should be considered including gaze palsy and 0.5% risk of mortality when performed bilaterally.
(III)Thalamotomy may be used to treat patients with unilateral somatic nociceptive/neuropathic body cancer pain, and may be more effective for pain involving the face and upper body.
(III)Cordotomy
Percutaneous image guided cordotomy may be used for the treatment of patients with unilateral somatic nociceptive/neuropathic body cancer pain with an expected durability of at least 6 mo. Potential complications, including temporary paresis, should be considered.
(II)Craniofacial Cancer Pain
Cranial nerve rhizotomy may be used for pain control in patients with craniofacial cancer pain.
(III)Nucleus caudalis DREZ may be used for pain control in patients with craniofacial cancer pain.
(III)Trigeminal tractotomy-nucleotomy may be used for pain control in patients with craniofacial cancer pain.
(III)There is insufficient evidence to recommend one procedure over the other (trigeminal tractotomy, cranial nerve rhizotomy, or caudalis DREZ) for pain control in patients with craniofacial cancer pain.
()Midline Subdiaphragmatic Visceral Cancer Pain
Myelotomy (open or percutaneous) may be used to treat patients with midline sub-diaphragmic visceral cancer pain.
(III)There is not enough evidence in literature to suggest a size of the myelotomy lesion or to favor open vs percutaneous method.
Disseminated Cancer Pain
Cingulotomy may be used in patients with diffuse cancer pain associated with metastatic disease. Risks of postoperative cognitive and behavioral problems should be considered.
(III)Recommendation Grading
Overview
Title
Neuroablative Procedures for Patients With Cancer Pain
Authoring Organization
Congress of Neurological Surgeons
Publication Month/Year
December 20, 2020
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Social worker, physician, nurse practitioner, nurse, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D000072716 - Cancer Pain
Keywords
cancer pain, Guidelines, central nervous system Ablation, Cordotomy, Myelotomy
Source Citation
Raslan AM, Ben-Haim S, Falowski SM, Machado AG, Miller J, Pilitsis JG, Rosenberg WS, Rosenow JM, Sweet J, Viswanathan A, Winfree CJ, Schwalb JM. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain. Neurosurgery. 2021 Feb 16;88(3):437-442. doi: 10.1093/neuros/nyaa527. PMID: 33355345; PMCID: PMC7884142.