Percutaneous CT-guided cordotomy for the treatment of pediatric cancer pain

Abstract

<jats:p>Percutaneous cordotomy using CT guidance has been shown to be a safe and effective means of reducing pain in adults with cancer in 2 large case series. Its effectiveness in pediatric patients, however, has not been reported. Here, the authors present a case of CT-guided percutaneous cordotomy being used effectively for the treatment of unilateral limb pain in a 9-year-old boy suffering from metastatic medulloblastoma. The efficacy and minimally invasive nature of this procedure support its use in selected pediatric cases.</jats:p>

Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer

“…Cord displacement up to 0.5 cm has been reported historically 21 and also can be observed in recent CT-guided cordotomies. 5,11,12,15 We observed no problems in our subjects due to spinal cord displacement, and the cord in subject 3 had returned to a normal position on MR imaging 2 days later (On-line Fig 2).…”

“…Several groups have performed myelography during the C1-2 puncture, but published images 4,12,14,15 suggested limited redistribution of viscous contrast because the patient cannot be moved. 5 We preferred a separate myelogram injection to plan the trajectory to the spinothalamic tract relative to the skin entry, lateral C1-2 window, and intrathecal spinal cord position.…”

“…4 Cordotomy also has been performed safely in a child. 12 Recent improvements in pain management have reduced the need for cordotomy to the point that the neurosurgery community is concerned that expertise in this procedure is disappearing. [8][9][10]13 Only 3 medical centers in the United States have reported performing cordotomy during the past decade.…”

“…[8][9][10]13 Only 3 medical centers in the United States have reported performing cordotomy during the past decade. 12,[14][15][16][17] Yet, a subset of patients with end-stage cancer with persistent incapacitating extremity pain not relieved by medical and intrathecal therapy could benefit from cordotomy if it were offered. Most interventional neuroradiologists have more experience than neurosurgeons in performing CT-guided ablative procedures and thus can help with these procedures as part of a multidisciplinary team.…”

Percutaneous cervical cordotomy in cancer pain

“…Reddy et al [12] showed that percutaneous cordotomy using CT guidance is safe and effective in reducing pain in paediatric patients suffering from metastatic medulloblastoma.…”