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Background: Neuralgic pain related to Pancoast-Tobias syndrome can be difficult to treat. An invasive but effective option for management is open cervical DREZotomy., Method: This procedure involves the interruption of the dorsal root entry zone (A delta and C fibers) that sustains the nociceptive pathways. After dura opening, the microsurgical steps are micro incisions of the pia mater under each dorsolateral rootlets and contiguous microcoagulations in the posterolateral sulcus downward to the posterior horn., Conclusion: When properly performed in a well-selected patient, DREZotomy is a safe and effective procedure for treating devastating pain related to Pancoast-Tobias syndrome., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)