Berger Assaf, Tellem Rotem, Arad Michal, Hochberg Uri, Gonen Tal, Strauss Ido
The Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv.
Sackler Faculty of Medicine, Tel Aviv University.
Harefuah. 2018 Feb;157(2):108-111.
Pain is one of the most common symptoms among cancer patients, and particularly in those who suffer from metastatic or terminal disease. There is great importance in delivering good pain management to these patients in order to alleviate their suffering, improve their functional status and their overall quality of life. In most cases, pain management is based on pharmacotherapy with opioids and other medications. However, there are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is associated with marked side effects. These patients, who suffer from refractory cancer pain, may benefit from neurosurgical procedures selectively intervening in different locations along the pain signaling pathways. This article summarizes several of these neurosurgical procedures: percutaneous cordotomy for unilateral pain, punctuate midline myelotomy for visceral pain and stereotactic cingulotomy for diffuse pain syndromes. This article demonstrates the use of careful patient selection by an interdisciplinary team which is critical for the success of these procedures. The team consists of palliative care specialists, pain specialists and a neurosurgeon. These neurosurgical interventions are presented through representative clinical cases, followed by a discussion of the clinical considerations that guided the choice of the therapeutic approach for each case.
疼痛是癌症患者最常见的症状之一，尤其是那些患有转移性疾病或终末期疾病的患者。为这些患者提供良好的疼痛管理对于减轻他们的痛苦、改善其功能状态和整体生活质量至关重要。在大多数情况下，疼痛管理基于使用阿片类药物和其他药物进行药物治疗。然而，有部分患者药物治疗无法实现可接受的疼痛缓解或伴有明显的副作用。这些患有难治性癌痛的患者可能会从神经外科手术中获益，这些手术可选择性地干预疼痛信号通路的不同部位。本文总结了其中几种神经外科手术：用于单侧疼痛的经皮脊髓切断术、用于内脏疼痛的点状中线脊髓切开术以及用于弥漫性疼痛综合征的立体定向扣带回切开术。本文展示了由多学科团队进行仔细的患者选择，这对这些手术的成功至关重要。该团队由姑息治疗专家、疼痛专家和神经外科医生组成。这些神经外科干预通过具有代表性的临床病例进行呈现，随后讨论指导每个病例治疗方法选择的临床考量因素。
