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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(03): 227-235
DOI: 10.1055/s-0036-1594260
Technical Note | Nota Técnica
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Mesencephalotomy, How I Do It: Analysis of 34 Cases

Mesencefalotomia, como eu faço: análise de 34 casos
Gustavo Veloso Lages
1   Pain Ambulatory, Hospital da Santa Casa de Montes Claros and of the Hospital Dilson Godinho, Montes Claros, MG, Brazil
,
José Oswaldo Oliveira Júnior 
2   Central Pain and Stereotaxy Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

08 June 2016

30 August 2016

Publication Date:
24 November 2016 (online)

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Abstract

The present paper aims to demystify the use of rostral mesencephalic reticulotomy (mesencephalotomy) in the treatment of chronic pain in cancer patients. A retrospective review of the medical records from the Central Pain and Stereotaxy Department of the A. C. Camargo Cancer Center, São Paulo, state of São Paulo, Brazil, between 2005 and 2012, was performed. Surgical indication was restricted to patients with cancer pain refractory to etiological and symptomatic treatments, > 2 months of expected survival, preserved cognition, and absence of coagulation disorders, of systemic infection, and of intracranial hypertension. We have selected 34 patients, with an average follow-up of 9.4 months, an average age of 54.3 years-old, and an average follow-up time until death of 6.4 months. Lung cancer was the most frequent diagnosis. Satisfactory and immediate pain relief was achieved in 91% of the cases, and 83% of these patients had no relapses. Among the complications, ocular movement disorder was the most frequent, but often transient. Permanent disturbances occurred in 8.8% of the cases (diplopia, rubral tremor, and paresthesia). Compared to the pharmacological treatment, mesencephalotomy was economically feasible, more effective, and improved quality of life. According to the data presented, it can be concluded that mesencephalotomy is a viable procedure for cancer pain control in selected cases.

Resumo

O presente artigo objetiva desmistificar o uso da reticulotomia rostral mesencefálica (mesencefalotomia) no tratamento da dor crônica em pacientes oncológicos. Foi realizada uma revisão retrospectiva dos prontuários dos pacientes submetidos a mesencefalotomia, entre 2005 e 2012, no Departamento da Central da Dor e Estereotaxia do A. C. Camargo Cancer Center, São Paulo, SP, Brasil. A indicação cirúrgica foi restrita aos portadores de dor oncológica refratária aos tratamentos etiológicos e sintomáticos, com expectativa de sobrevida > 2 meses, cognição preservada, ausência de distúrbios de coagulação, de infecção sistêmica, e de hipertensão intracraniana. Foram selecionados 34 pacientes, com seguimento médio de 9,4 meses, idade média de 54,3 anos, tempo médio de seguimento até o óbito de 6,4 meses. O câncer de pulmão foi o diagnóstico mais frequente. Houve alívio satisfatório e imediato da dor em 91% dos casos, e 83% não tiveram recidivas. Dentre as complicações, o distúrbio da movimentação ocular foi o mais frequente, sendo em sua maioria de caráter transitório. Distúrbios permanentes ocorreram em 8,8% dos casos (diplopia, tremor rubral, e parestesia). No que se refere à comparação com o tratamento farmacológico, o procedimento mostrou-se economicamente viável, mais efetivo, além de fornecer qualidade de vida. Com os dados apresentados, foi permitido concluir que a mesencefalotomia é um procedimento viável para o controle da dor oncológica.

Keywords

pain - functional neurosurgery - facial pain - cancer pain - ablative procedure

Palavras-chave

dor - neurocirurgia funcional - dor facial - dor oncológica - cirurgia ablativa
 

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