Percutaneous Cervical Cordotomy for Refractory Cancer Pain With General Anesthesia and Neuromonitoring: A Case Report.

BACKGROUND

Cancer-related pain remains one of the most debilitating symptoms in patients with advanced malignancy, with a significant proportion experiencing pain refractory to standard medical therapy. Percutaneous cordotomy is an established intervention targeting the spinothalamic pathway and can provide meaningful relief in appropriately selected patients; however, its use has declined and is typically performed in awake patients.

CASE PRESENTATION: A 54-year-old woman with metastatic gallbladder carcinoma presented with severe, unilateral, nociceptive abdominal pain refractory to medical and interventional treatments. Given her limited life expectancy and persistent symptoms, she underwent percutaneous cervical cordotomy. At the patient's request, the procedure was performed under general anesthesia. We achieved excellent localization for safe ablation using intraoperative CT and neuromonitoring guidance. Postoperatively, she reported complete resolution of her primary pain (8-10/10 to 0/10) on postoperative Day 1. She developed expected contralateral "mirror pain," which was less severe and manageable. Pain relief was sustained during early follow-up, although later recurrence was attributed to disease progression rather than procedural failure.

CONCLUSION

This case demonstrates that percutaneous cordotomy can be performed safely and effectively under general anesthesia with the aid of intraoperative CT and neuromonitoring. This approach may expand the applicability of cordotomy in carefully selected patients with refractory cancer pain, particularly when patient comfort is a priority.