Presented at the 2013 AAPM Annual Meeting « Back

Combined Radiofrequency/Intrathecal Alcohol Ablation for Pain Due to Metastatic Astrocytoma in Terminal Patients

Daisy Munoz, munoz1009@yahoo.com¹, Andrew G. Kaufman, MD¹, (1) New Jersey Medical School, Newark, New Jersey

Oncologists often refer terminal cancer patients for “spinal morphine pumps” even with life expectancy less than 3 months. We present a case of combined Radiofrequency (RF) /Intrathecal Alcohol ablation in a 23 year old with metastatic Astrocytoma. Due to the pattern of pain, which was described as burning with occasional electric shocks and after review of the CT scan the plan was for ablation of the dorsal root of L2 and L3. The patient was bedridden and incontinent. Utilizing standard sterile technique, under fluoroscopic guidance a 100mm with 5mm active tip RF needle was placed within each neural foramen. Stimulation at 50Hz reproduced pain pattern at .3volts for L2 and .1 volt at L3. Aspiration prior to injection of lidocaine 2% was positive for CSF at L3-4.Regardless the decision was to ablate at both levels at 80 degrees celsius for 90 seconds. While there was significant improvement there was still diffuse nonspecific pain on the left leg. The decision was made to utilize the positive CSF flow of the L3 needle. A 75% alcohol solution was created utilizing Omnipaque 300 and injected in .5 ml increments, re-assessing every 10 minutes until he reported being pain free. A total of 2ml was injected. He expired 3 months later with pain well controlled. In terminal cancer patients with short term life expectancies ablative techniques offer cost effective management versus implantation of a "morphine pump". This combined technique afforded significant efficacy in the treatment of both somatic and neuropathic mediated pain mechanism. References: 1) Cleeland CS, GoninR, Hatfield AK et al. Pain and its treatment in outpatients with metastatic cancer. N.Engl.J. Med. 330(9), 592-596 (1994).

Funding: None