5.4 Neurosurgery

Neurosurgical procedures for the relief of pain include neuroablation, implantation of drug infusion systems, and neuroaugmentation. Published estimates of the percentage of patients who require neurosurgical procedures to control cancer-related pain vary but are nearly all fewer than lo percent. Nevertheless, long-standing clinical experience supports a view that neurosurgical intervention is appropriate for patients in whom more conservative treatment is neither tolerated nor effective (or is unlikely to be effective) and for whom the expertise and followup care are available. The choice of procedure is based on the location and type of pain (somatic, visceral, deafferentation), the general condition of the patient, the life expectancy, and the expertise available.

There is no simple, entirely safe procedure to alleviate cancer-related pain. Depending on the clinical setting and procedure, the risks of neurosurgical operation include new pain symptoms from nerve damage at the site of incision or nerve division, recurrence of pain after a transiently successful result, and postoperative necrologic impairment. These risks must be balanced against an ideal possible outcome of abolition of pain with little or no need for medication. In a particular clinical situation, a lack of personnel with experience in carrying out and following up other invasive therapies may warrant greater reliance on neurosurgical options (e.g., cordotomy instead of epidural catheter for pain of pelvic tumor). Because appropriate patient selection is essential, each proposed neurosurgical intervention is best reviewed by a team of oncologists, pain specialists, psychotherapists, and neurosurgeons.

The following discussion addresses only procedures that are in general use and for which reported results can be meaningfully assessed. Classic (White and Sweet, 1969) and recent textbooks and monographs provide current reviews of all of these procedures (Bonica, 1990; Gybels and Sweet, 1989; Patt, 1993)

Related Chunks

NONPHARMACOLOGIC INTERVENTIONS: INVASIVE THERAPIES

Introduction (Invasive nonpharmacologic interventions)

Brachytherapy

Peripheral Neurectomy

Surgery

Surgical Management of Pain due to Primary or Metastatic Tumor

Pain as a Consequence of Operation

Anxiety

Index