Stereotactic Transsphenoidal Hypophysectomy by Radiofrequency for Chronic Pain from Hormone-Independent Metastatic Tumors: A New Perspective

Abstract

Introduction: In 1953, Luft and Olivecrona described surgical ablation of the pituitary gland in the treatment of metastases from hormone-dependent tumors, with a view to reduce the spread of the disease rather than specifically for analgesia. The mechanism of hypophysectomy remains uncertain, but it has been suggested that part of the effect may be a result of the spread of physical-chemical agent through the pituitary stalk into the hypothalamus, thereby directly causing fixation, or indirectly causing thrombosis and infarction. The possibility of treating the pain in independent-hormonal tumors was tested, and presented satisfactory results. Based on that, we performed a stereotaxic transsphenoidal hypophysectomy by radiofrequency in a palliative patient. Case Report: 54 year-old female patient, who was a smoker. In december, 2015, she started presenting dorsal back pain, radiating to the lower back, hip and medial thighs bilaterally, in distress, continuous, progressive, without triggering factors for worsening or improvement, which got worse on palpation. In March 2016, she was investigated at Hospital das Clinicas, School of Medicine, USP. Computed tomography of chest, abdomen and pelvis (03/14/2016): Multiple osteolytic lesions, lung mass in the left lower lobe base of 4.7 cm, diffuse injury in thoracic, lumbar and sacral-iliac spine. Iliac Biopsy (03/15/2016): mucinous adenocarcinoma. After staging, Oncology opted for palliative treatment. Pain treatment showed unsatisfactory analgesia. Due to that, it was proposed stereotactic transsphenoidal hypophysectomy by radiofrequency. Procedure was performed in April 14th, 2016, uneventfully Patient had considerable improvement in bone pain in the immediate postoperative day (VAS=0), getting back to walking. She kept hospitalizated until the fourth postoperative day. She was discharged on April 18th, 2016. Conclusion: The procedure rises as an interesting option for refractory metastatic bone pain, presenting the advantage of fast resolution of intense pain and low rate of complications, diminishing hospitalization days, which is a fundamental aspect to be observed in these palliative patients