Neurosurgical Interventions for Cancer Pain Management
Summary
Cancer pain that proves refractory to pharmacological treatment poses a major burden on patients and healthcare systems worldwide. Neurosurgical interventions offer targeted approaches to interrupt pain pathways or modulate neural circuits, thereby reducing analgesic requirements and improving quality of life. Ablative techniques, such as cordotomy and dorsal root entry zone lesioning, selectively disrupt nociceptive transmission in the spinal cord, most often via radiofrequency or CT‐guided radioablation. Chemical ablation of central structures, notably neuroadenolysis of the pituitary gland, employs alcohol or other neurolytic agents to attenuate pain mediators in advanced malignancy. Neuromodulatory strategies—including intrathecal drug delivery systems, spinal cord stimulation and motor cortex stimulation—provide reversible and adjustable pain control by altering nociceptive processing. Patient selection hinges on tumour type, expected survival and distribution of pain, while advances in imaging and intraoperative monitoring have reduced complication rates. Growing evidence supports earlier referral for neurosurgical consultation within comprehensive cancer pain pathways to optimise functional outcomes and decrease opioid dependency.
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Neurosurgical Interventions for Cancer Pain Management publication trend
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Technical terms
Cordotomy: A percutaneous or open surgical technique that ablates the anterolateral spinothalamic tract to interrupt pain transmission from the contralateral body.
Dorsal root entry zone (DREZ) lesioning: Targeted destruction of the entry zone of sensory afferents in the dorsal horn to alleviate intractable neuropathic and cancer‐related pain.
Neuroadenolysis: Chemical ablation of the pituitary gland, typically via injected alcohol, to reduce hormonal or peptidergic mediators of cancer pain.
References
- Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer. American Journal of Neuroradiology (2016).
- Percutaneous cervical cordotomy for cancer-related pain: national data. BMJ Supportive & Palliative Care (2020).
- Neuroadenólise Hipofisária: Alternativa Terapêutica para a Dor no Câncer Avançado. Revista Brasileira de Cancerologia (2023).
- Fundamentos anátomo-quirúrgicos de la zona de entrada de la raíz dorsal. NeuroTarget (2016).
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