W Jeffrey Elias, Chang-Chia Liu, Divine Nwafor, Patrick H Finan, Mark Quigg, Shayan Moosa
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引用次数: 0
Abstract
Introduction: Historically, stereotactic mesencephalotomy was developed as a "supraspinal" cordotomy for cancer and neuropathic pain. Early experiences relieved pain, but the procedure was never widely adopted because of the associated morbidity with midbrain lesioning. Contemporary image-guided lesioning could make this a feasible procedure for cancer patients suffering with pain.
Methods: A single-center, nonrandomized, early phase trial was designed to treat patients with severe, refractory pain from head and neck cancer with unilateral MRI-guided focused ultrasound mesencephalotomy. Safety was the primary outcome, but measures of efficacy were assessed with pain intensity and more functional components of pain.
Results: A discrete midbrain lesion was created for the 5 patients. All patients with advanced cancer had limited survival of less than 3 months, but they tolerated the procedure and experienced pain relief to different degrees. Two had profound pain relief, one was partial, and two others were very brief. One patient was transiently obtunded and other procedural morbidities were mild: numbness (3), oculomotor disturbance (1), and agitation (1). Electroencephalography, somatosensory evoked potentials, and quantitative sensory testing were obtained when possible.
Conclusion: Stereotactic focused ultrasound mesencephalotomy is a modern, image-guided, lesioning technique that may be effective for cancer pain.
期刊介绍：
''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.
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