Nucleus caudalis DREZ for facial pain due to cancer.

Five cancer patients underwent nucleus caudalis DREZ operations for medically refractory facial pain. Etiologies included a posterior fossa microglioma, a lacriminal gland carcinoma, a temporal meningioma, a parasellar tumor (craniopharyngioma), and an orbital fibrosarcoma. Postoperative results were graded as excellent (complete pain relief), good (pain decreased, activity not limited), fair (pain present, but less than before surgery, activity limited), and poor (pain same or worse than before surgery). Immediately following surgery, all patients reported good or excellent pain relief. On later followup (mean = 14.4 mo), three of our five patients reported a significant improvement in pain and level of activity. The remaining two patients reported that the pain was less than before surgery but that their activity was still limited because of the pain. We conclude that the nucleus caudalis DREZ operation is useful in treating medically refractory facial pain due to cancer. At this time, it appears that patients with burning pain, no hyperesthesias, and no previous neuroablative procedures have the better chance at a successful outcome.