Dorsal root entry zone lesions for treatment of pain-related to radiation-induced plexopathy.

Abstract

Case series. Presentation of results of dorsal root entry zone lesions in 10 patients suffering from severe neuropathic pain due to brachial plexopathy or radiation-induced trigeminal neuropathy. Radiation-induced neuropathy is an uncommon but serious complication of radiotherapy. It may cause delayed motor and sensitive impairment associated with severe treatment-resistant pain. Various therapeutic approaches have been reported aimed at controlling radiation-induced neuropathy-pain, demonstrating poor outcomes. Eight patients with plexopathy underwent dorsal root entry zone lesion in the cervical spinal cord, while 2 other subjects received stereotactic trigeminal nucleotractotomy. Subjects were followed prospectively before and after brachial dorsal root entry zone or trigeminal caudal operations (range 0.5-36 months). All patients experienced improvement in pain conditions. A total of 8 patients reported full pain relief (visual analog scale = 0) by the end of the follow-up period. The remaining patients had partial control of pain. One patient required reoperation to achieve optimal pain relief. Both patients who underwent trigeminal nucleotractotomy had transient ataxia in the ipsilateral upper limb. One of the patients treated by dorsal root entry zone lesion had minor aggravation of weakness of the ipsilateral lower limb. The present results suggest that the trigeminal nucleotractotomy and dorsal root entry zone lesions in cervical spinal cord are an effective procedure for the treatment of pain associated with actinic peripheral neuropathy.