Cryoablation of the adenohypophysis in the treatment of refractory pain syndrome in patients with intracerebral and visceral metastases (clinical cases)

Background. Chronic refractory pain is observed in nearly half of patients with stage IV cancer, significantly reducing quality of life and necessitating novel effective analgesic approaches. Purpose – to retrospectively assess the effectiveness of selective stereotactic transnasal transsphenoidal cryoablation of the adenohypophysis as a treatment for refractory pain syndrome and its impact on quality of life in female patients with stage IV disseminated/ recurrent cutaneous melanoma and existing intracerebral and visceral metastases. Materials and Methods. This study analyzed two clinical cases of refractory pain syndrome in women aged 44 and 52 with stage IV cutaneous melanoma and multiple metastases (intracerebral, lymphatic, bone, pleural). To reduce life-threatening risks and achieve prolonged analgesia, craniotomies with total metastasis removal and microneurosurgical interventions were performed. Surgeries were conducted in a neurosurgical clinic between 2012 and 2015. Pain was assessed using the Numerical Rating Scale (NRS), and quality of life was evaluated using the modified ESAS-R. Monitoring was performed pre- and post-intervention at 6–12 hours, 3 days, and 1, 3, 6, 12, 18, 24, and 36 months. Results. Before the intervention, pain intensity ranged from 6 to 8 points on the NRS. Following microneurosurgical treatment, pain decreased to 1–3 points within the first 12 hours and remained at 0–2 points for up to 36 months. Quality of life scores (ESAS-R) declined from 24–39 to 0–12 points over the observation period. A sustained reduction in pain and stable improvement in quality of life were observed throughout the 3-year follow-up. Conclusions. Selective stereotactic cryoablation of the adenohypophysis provides long-term pain relief and improves quality of life in patients with stage IV melanoma and metastases refractory to standard therapy.