CT-Guided Pain Procedures for Intractable Pain in Malignancy

1995 ◽  
pp. 88-91 ◽  
Author(s):  
Y. Kanpolat ◽  
S. Caglar ◽  
S. Akyar ◽  
C. Temiz
Keyword(s):  
Intractable Pain ◽  
Ct Guided

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

2020 ◽  
Vol 37 (8) ◽  
pp. 619-623 ◽  
Author(s):  
John David Prologo ◽  
Sivasai Manyapu ◽  
Zachary L. Bercu ◽  
Ashmit Mittal ◽  
Jason W. Mitchell
Keyword(s):  
Computed Tomography ◽  
Pelvic Pain ◽  
Pudendal Nerve ◽  
Intractable Pain ◽  
Pelvic Neoplasms ◽  
Ct Guided ◽  
Patient Demographics ◽  
Pain Scores ◽  
The Mean ◽  
Mean Time

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.

scholarly journals Computerized tomography-guided percutaneous extralemniscal myelotomy

1997 ◽  
Vol 2 (1) ◽  
pp. E7 ◽  
Author(s):  
Yücel Kanpolat ◽  
Ali Savas ◽  
Sükrü Çaglar ◽  
Serdar Akyar
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Computerized Tomography ◽  
Intractable Pain ◽  
Lesion Volume ◽  
Neurophysiological Mechanism ◽  
Ct Guided ◽  
Cervicomedullary Junction ◽  
Total Pain ◽  
Intractable Cancer Pain

Extralemniscal myelotomy (ELM) is a procedure performed at the cervicomedullary junction of the spinal cord in which the central cord is lesioned to treat intractable pain. The neurophysiological mechanism of pain relief after ELM remains unclear. The authors present a series of 14 patients with intractable cancer pain who were managed by CT-guided, percutaneous ELM. In six of the cases (42.8%), total pain relief was achieved; partial satisfactory pain relief was attained in four cases (28.5%), and no pain control was achieved in four cases (28.5%). No complications due to ELM were observed. The authors believe that ELM is a safe and effective procedure in the management of intractable cancer pain for selected cases; computerized tomography guidance is an essential part of the procedure to achieve morphological localization of the target in the cervicomedullary junction. More research is needed to understand the neurophysiological mechanism of pain relief after ELM and to standardize the lesion volume.

Computerized tomography-guided percutaneous bilateral selective cordotomy

1997 ◽  
Vol 2 (1) ◽  
pp. E6 ◽  
Author(s):  
Yücel Kanpolat ◽  
Ali Savas ◽  
Sükrü Çaglar ◽  
Cüneyt Temiz ◽  
Serdar Akyar
Keyword(s):  
Cancer Patients ◽  
Computerized Tomography ◽  
Electrode System ◽  
Needle Electrode ◽  
Intractable Pain ◽  
Spinothalamic Tract ◽  
Ct Guided ◽  
Lower Trunk ◽  
Reticulospinal Tract ◽  
Bilateral Destruction

Percutaneous bilateral cordotomy performed using conventional techniques may cause the patient to develop sleep-induced apnea due to bilateral destruction of the ventrolateral reticulospinal tract. Computerized tomography (CT)-guided percutaneous cordotomy using a newly designed needle electrode system has the advantages of safe, selective, and controlled lesioning under direct visualization in the lateral spinothalamic tract. Given its low complication rate, bilateral selective cordotomy performed with CT guidance using this new needle electrode system may prove to be the treatment of choice for cancer patients with bilateral pain of the lower trunk and extremities. The present series included five cancer patients suffering from intractable pain bilaterally in the lower trunk and extremities. All were treated with CT-guided bilateral selective cordotomy: the results demonstrate that this technique may be used effectively and safely.

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

2016 ◽  
Vol 38 (2) ◽  
pp. 387-390 ◽  
Author(s):  
T.M. Shepherd ◽  
M.J. Hoch ◽  
B.A. Cohen ◽  
M.T. Bruno ◽  
E. Fieremans ◽  
...  
Keyword(s):  
Intractable Pain ◽  
Ct Guided ◽  
Patients With Cancer

CT guided neurolytic blockade of the coeliac plexus in patients with advanced and intractably painful pancreatic cancer

2018 ◽  
Vol 18 (2) ◽  
pp. 247-251 ◽  
Author(s):  
Jan Henrik Rosland ◽  
Jonn Terje Geitung
Keyword(s):  
Pancreatic Cancer ◽  
Side Effects ◽  
Pain Treatment ◽  
Advanced Pancreatic Cancer ◽  
Life Time ◽  
Optimal Placement ◽  
Injection Pain ◽  
Intractable Pain ◽  
Ct Guided ◽  
Needle Position

Abstract Background and aims: Pain caused by infiltrating pancreatic cancer is complex in nature and may therefore be difficult to treat. In addition to conventional analgesics, neurolytic blockade of the coeliac plexus is often recommended. However, different techniques are advocated, and procedures vary, and the results may therefore be difficult to compare. Therefore strong evidence for the effect of this treatment is still lacking, and more studies are encouraged. Our aim was to describe our technique and procedures using a Computer Tomograph (CT) guided procedure with a dorsal approach and present the results. Methods: The procedures were performed in collaboration between a radiologist and an anaesthesiologist. All patients had advanced pancreatic cancer. The patients were placed in prone position on pillows, awake and monitored. Optimal placement of injection needles was guided by CT, and the radiologist injected a small dose of contrast as a control. When optimal needle position, the anaesthesiologist took over and completed the procedure. At first 40 mg methylprednisolone was injected to prevent inflammation. Thereafter a mixture of 99% ethanol diluted to 50% by ropivacaine 7.5 mg/mL to a total amount of 20–30 mL per needle was slowly injected. Repeated aspiration was performed during injection to avoid intravasal injection. Pain treatment and pain score was recorded and compared before and after the treatment. Results: Eleven procedures in 10 patients were performed. Age 49–75, mean 59 years. Median rest life time was 36 days (11–140). Significant reduction of analgesics was observed 1 week after the procedure, and most patients also reported reduction of pain. No serious side effects were observed. Conclusions: CT guided neurolytic celiac plexus blockade is a safe and effective treatment for intractable pain caused by advanced pancreatic cancer. Not all patients experience a significant effect, but the side effects are minor, and the procedure should therefore be offered patients experiencing intractable cancer related pain.

Efficiency and safety of percutanous CT-guided cryoablation of celiac plexus in treating intractable pain caused by pancreatic cancer

2013 ◽  
Vol 24 (4) ◽  
pp. S131 ◽  
Author(s):  
H. Yarmohammadi ◽  
K. Mortell ◽  
J.D. Prologo ◽  
N. Azar ◽  
J. Haaga ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Celiac Plexus ◽  
Intractable Pain ◽  
Ct Guided

Computed Tomography-guided Percutaneous Cordotomy for Intractable Pain in Malignancy

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS187-ONS194 ◽  
Author(s):  
Yucel Kanpolat ◽  
Hasan Caglar Ugur ◽  
Murat Ayten ◽  
Atilla Halil Elhan
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
The Body ◽  
Karnofsky Performance Scale ◽  
Intractable Pain ◽  
Spinothalamic Tract ◽  
Ct Guided ◽  
Cancer Group ◽  
Percutaneous Cordotomy ◽  
Scale Scores

Abstract Objective: Pain, usually a response to tissue damage, is accepted as an unpleasant feeling generating a desire to escape from the causative stimulus. Although, in the early stages of malignant diseases, pain is seen in 5% to 10% of cases, this rate reaches nearly 90% in the terminal stage, and pain becomes a primary symptom. Cordotomy is one of the treatment choices in pain caused by malignancies localized unilaterally to the extremities as well as the thorax and the abdomen. Methods: The target of computed tomography (CT)-guided percutaneous cordotomy is the lateral spinothalamic tract located in the anterolateral region of the spinal cord at the C1–C2 level. Between 1987 and 2007, CT-guided percutaneous cordotomies were performed in 207 patients; most (193 patients) suffered from intractable pain related to malignancy. The patients” pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively. Results: The initial success rate of CT-guided percutaneous cordotomy was 92.5%. The success rate was higher in the malignancy group. In the cancer group, selective cordotomy (pain sensation denervated only in the painful region of the body) was achieved in 83%. In 12 cases, bilateral selective percutaneous cordotomy was successfully applied. Conclusion: In the treatment of intractable pain, CT-guided cordotomy is an option in specially selected cases with malignancy. In this study, anatomic and technical details of the procedure and the experience gained from treating 207 patients over a 20-year period are discussed.

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