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Anisimov ED, Rzaev JA, Moysak GI, Dmitriev AB, Duff IE, Slavin KV. Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review. Stereotact Funct Neurosurg 2023; 101:387-394. [PMID: 37931603 DOI: 10.1159/000534488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Nucleotractotomy is an efficient surgical technique that provides a high pain relief rate for specific clinical indications. There are two main approaches for performing this operation: an open and percutaneous technique. METHODS In the Federal Center of Neurosurgery (Novosibirsk, Russia) from 2016 to 2022, 13 trigeminal nucleotractotomies (7 open and 6 percutaneous) were performed in 12 patients (5 women and 7 men). The indications for surgery were deafferentation pain and chronic drug-resistant pain syndrome caused by malignancy in the facial region. A neurological examination was done on each patient 1 day before the surgery, right after the surgery, and at the follow-up (examinations were done after 1, 6, and 12 months, or when the patient independently applied to our hospital). In the early postoperative period, patients underwent brain MRI. RESULTS The average pain intensity score before nucleotractotomy on the 11-point (0-10) visual analog scale (VAS) was 9.3. The effectiveness of open interventions was somewhat higher; the average VAS score in the early postoperative period for the open technique was 1.57, in the group of patients who underwent percutaneous nucleotractotomy were 2.66. Complete regression of the pain syndrome was achieved in 6 patients; in 5 patients, the pain in the face decreased by more than 50%. One case had an unsatisfactory outcome. In the open-surgery group in the early postoperative period, according to MRI, the average length of the visualized area of signal change was longer (21.5 mm, the average diameter was 3.75 mm) than in a percutaneous nucleotractotomy group (16 mm, the average diameter was 3.75 mm). During the postoperative period (average follow-up 40 months), the pain recurred in 3 patients (30%): 2 patients after percutaneous nucleotractotomy (3 and 18 months after surgery) and in 1 patient 4 months after the open surgery. The mean VAS score at the last follow-up was 2.6. CONCLUSION Trigeminal nucleotractotomy is an effective approach to the treatment of intractable facial pain. Our experience suggests this technique is highly effective in patients with drug-resistant pain caused by craniofacial tumors and deafferentation conditions after treating trigeminal neuralgia.
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Affiliation(s)
| | - Jamil A Rzaev
- Federal Neurosurgical Center, Ministry of Health of Russia, Novosibirsk, Russian Federation
| | - Galina I Moysak
- Federal Neurosurgical Center, Ministry of Health of Russia, Novosibirsk, Russian Federation
| | - Alexander B Dmitriev
- Federal Neurosurgical Center, Ministry of Health of Russia, Novosibirsk, Russian Federation
| | - Irina E Duff
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA
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Raslan AM, Ben-Haim S, Falowski SM, Machado AG, Miller J, Pilitsis JG, Rosenberg WS, Rosenow JM, Sweet J, Viswanathan A, Winfree CJ, Schwalb JM. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain. Neurosurgery 2021; 88:437-442. [PMID: 33355345 DOI: 10.1093/neuros/nyaa527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures. OBJECTIVE To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain. METHODS A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded. RESULTS In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain. CONCLUSION Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.
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Affiliation(s)
- Ahmed M Raslan
- Department of Neurological Surgery, School of Medicine, Oregon Health & Science University Healthcare, Portland, Oregon
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | | | - André G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan Miller
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Julie G Pilitsis
- Department of Neurosurgery and Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Sweet
- Department of Stereotactic & Functional Neurosurgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Christopher J Winfree
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan
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Reddy GD, Okhuysen-Cawley R, Harsh V, Viswanathan A. Percutaneous CT-guided cordotomy for the treatment of pediatric cancer pain. J Neurosurg Pediatr 2013; 12:93-6. [PMID: 23682820 DOI: 10.3171/2013.4.peds12474] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Percutaneous cordotomy using CT guidance has been shown to be a safe and effective means of reducing pain in adults with cancer in 2 large case series. Its effectiveness in pediatric patients, however, has not been reported. Here, the authors present a case of CT-guided percutaneous cordotomy being used effectively for the treatment of unilateral limb pain in a 9-year-old boy suffering from metastatic medulloblastoma. The efficacy and minimally invasive nature of this procedure support its use in selected pediatric cases.
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Affiliation(s)
- Gaddum D Reddy
- Departments of Neurosurgery, MD Anderson Cancer Center, Houston, Texas, USA
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Raslan AM, Cetas JS, McCartney S, Burchiel KJ. Destructive procedures for control of cancer pain: the case for cordotomy. J Neurosurg 2011; 114:155-70. [DOI: 10.3171/2010.6.jns10119] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Historically, destructive procedures for cancer pain were the main line of treatment therapy. However, the use of high-dose opioids has essentially replaced such procedures. Recognition of the limits of medical therapy to treat cancer pain effectively is growing, while conversely, in regions with limited access to pain medications, the importance of destructive surgical techniques is increasing. A critical evaluation of the evidence for destructive techniques is warranted, and the authors review current evidence underlying these procedures.
Methods
A US National Library of Medicine PubMed search for “ablation,” “DREZ,” “dorsal root entry zone,” “cingulotomy,” “cordotomy,” “ganglionectomy,” “mesencephalotomy,” “myelotomy,” “neurotomy,” “neurectomy,” “rhizotomy,” “sympathectomy,” “thalamotomy,” “tractotomy,” and “pain” was undertaken. The search was then limited to human studies, English-language literature, cancer pain, and reports with more than 1 patient.
Results
One hundred twenty papers were identified and reviewed based on the selection criteria described. According to the Canadian and US task forces, classification of clinical research literature only “sympathectomy” was supported by Class I or II studies, with 2 Class I papers and 1 Class II paper identified for cancer pain. All other procedures were supported by Class III studies of variable quality. Cordotomy in particular was the most extensively studied and reviewed procedure. Given the large number of patients studied, consistent results, multiplicity of reports and, even though evidence quality for individual studies was relatively low, cumulative evidence suggests that cordotomy may play an important role in the treatment of cancer pain.
Conclusions
Destructive procedures for cancer pain may play more than a historic role in the management of cancer pain. Cumulative evidence from even the poorest quality studies suggests that some procedures, such as cordotomy, should be included in the armamentarium available to the neurosurgeon today. To renew appropriate interest in these procedures, evidence and studies that meets today's evidence-based research criteria are warranted.
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Kanpolat Y, Ugur HC, Ayten M, Elhan AH. Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy. Neurosurgery 2009; 64:ons187-93; discussion ons193-4. [PMID: 19240568 DOI: 10.1227/01.neu.0000335645.67282.03] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Pain, usually a response to tissue damage, is accepted as an unpleasant feeling generating a desire to escape from the causative stimulus. Although, in the early stages of malignant diseases, pain is seen in 5% to 10% of cases, this rate reaches nearly 90% in the terminal stage, and pain becomes a primary symptom. Cordotomy is one of the treatment choices in pain caused by malignancies localized unilaterally to the extremities as well as the thorax and the abdomen. METHODS The target of computed tomography (CT)-guided percutaneous cordotomy is the lateral spinothalamic tract located in the anterolateral region of the spinal cord at the C1-C2 level. Between 1987 and 2007, CT-guided percutaneous cordotomies were performed in 207 patients; most (193 patients) suffered from intractable pain related to malignancy. The patients' pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively. RESULTS The initial success rate of CT-guided percutaneous cordotomy was 92.5%. The success rate was higher in the malignancy group. In the cancer group, selective cordotomy (pain sensation denervated only in the painful region of the body) was achieved in 83%. In 12 cases, bilateral selective percutaneous cordotomy was successfully applied. CONCLUSION In the treatment of intractable pain, CT-guided cordotomy is an option in specially selected cases with malignancy. In this study, anatomic and technical details of the procedure and the experience gained from treating 207 patients over a 20-year period are discussed.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, Ankara University School of Medicine, Sihhiye, Ankara, Turkey
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Abstract
The subject of human pain can be subdivided into two broad categories: physical pain and psychological pain. Since the dawn of human consciousness, each of these two forms of pain-one clearly physical, the other having more to deal with the mind-have played a central role in human existence. Psychological pain and suffering add dimensions that go far beyond the boundaries of its physical counterpart. In the past 50 years, one of the more remarkable accomplishments of medical science has been to increasingly enable the clinician to impact, as never before, each of these critical realms of human existence. Our intention is, therefore, to initially describe a few of the many exciting neuroscientific and neurosurgical advances that have been made in the treatment of various types of pain and to speculate on some of the emergent questions that we believe need to be addressed. After this is accomplished, we will then use this information as a kind of two-pronged philosophical entrance into questions of the mind, brain, and soul that we feel are necessary to bring back into the sphere of the modern physician's practice. The goal of this article is two-fold: 1) to share some of our exciting research and 2) to renew the interest in timeless questions, such as that of the mind-brain and the brain-mind, in the conversation of the modern neurosurgeon. The International Association for the Study of Pain divides pain into two broad functions and anatomical categories. In this framework, "nociceptive" pain is defined as the kind of physical pain that results when the tissue is damaged. Given this perspective, such pain is usually considered a consequence of one's defense against one's environment. The other pain is the "neuropathic" one resulting from a lesion or a dysfunction of the human nervous system. As such, we will take the risk of crossing beyond the boundaries of neurosurgery and venture into boundaries that, at another time, might seem more natural to the discipline of psychiatry for two reasons. The first is that psychiatry seems to be so focused on the brain-its biochemistry and pharmacology--that questions of mind and soul have become rare and almost negligible. The second is to follow the course of the results of our own clinical investigations that have taken us into that very human world where questions of physical pain, psychological pain, and the experience of suffering abound. Today, however, the strategy of neuromodulation offers the advantage of being precisely tailored in neuroanatomical terms and, even more importantly, of being altogether reversible. At both our own Istituto Neurologico C. Besta and many other neurosurgical centers worldwide, many procedures have been reported in which implant neuromodulation devices successfully treat pain. For example, long-term stimulation of the spinal cord has been fairly effective in the treatment of neuropathic pain, multiple sclerosis, and various other forms of pain. Good results have been obtained in treating peripheral vascular diseases and sympathetic reflex dystrophy syndrome. Good results have also been achieved in trigeminal nerve stimulation and peripheral nerve stimulation. In the case of thalamic stimulation, there has also been an improvement of symptoms, but a long-term degree of tolerance was noticed. Hypothalamic stimulation has also been seen to be effective in controlling trigeminal autonomic cephalalgic pain, as well as the facial pain that is known to occur in multiple sclerosis. Motor cortex stimulation was found to occasionally have good results in treating neuropathic pain, whereas occipital nerve stimulation was found to achieve good results in controlling chronic cluster headache and other chronic headaches, although with only short-term follow-up so far. Recent reports of functional magnetic resonance imaging have prompted us to propose exciting new neurosurgical targets that may be effective in treating psychoaffective disorders. Our results appear to be more than promising so far. It appears that neuropathic pain and psychoaffective disorders seem to be sharing an anatomophysiological common background at the Brodmann Area 25 of the anterior cingulated gyrus. On the basis of these exciting findings, we believe that it is reasonable to suggest that neuropathic pain and psychoaffective disorders may ultimately be managed with complementary or, at least, similar, therapeutic strategies, each of which lie within the domain of the neurosurgeon.
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Affiliation(s)
- Giovanni Broggi
- Department of Neurosurgery, Istituto Neurologico C. Besta, Milan, Italy.
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Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH. Computed Tomography-guided Percutaneous Trigeminal Tractotomy-nucleotomy. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000320139.27501.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia.
Methods:
In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients’ pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1).
Results:
The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal neuralgia were also effectively treated with TR-NC.
Conclusion:
We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Hasan C. Ugur
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, School of Medicine, Ankara University, Sihhiye, Turkey
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Kanpolat Y, Tuna H, Bozkurt M, Elhan AH. Spinal and Nucleus Caudalis Dorsal Root Entry Zone Operations for Chronic Pain. Oper Neurosurg (Hagerstown) 2008; 62:235-42; discussion 242-4. [DOI: 10.1227/01.neu.0000317398.93218.e0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
Dorsal root entry zone (DREZ) operations came into medical practice after the demonstration of increased electrical activity in the dorsal horn of the spinal cord and brainstem in patients with deafferentation of the central nervous system after injury to these areas. The aim of the study was to describe the technique and the effectiveness of spinal DREZ and nucleus caudalis (NC) DREZ operations, which may be the treatments of choice in unique chronic pain conditions that do not respond to medical therapy or any other surgical methods.
Methods:
Fifty-five patients (44 spinal, 11 NC DREZ) underwent 59 (48 spinal, 11 NC DREZ) operations. There were 44 men and 11 women with a mean age of 46.4 years (range, 24–74 yr). The mean follow-up period was 72 months (range, 6 mo–20 yr). Follow-up assessments were performed with clinical examination on the first day and in the sixth and twelfth months postoperatively. Patients' pain scores and Karnofsky Performance Scale scores were also evaluated pre- and postoperatively.
Results:
The initial success rates for spinal and NC DREZotomy procedures were 77 and 72.5%, respectively. In the spinal DREZotomy group, mortality occurred in one patient (2.2%). There were two cases of transient muscle weakness (4.4%) and two of cerebrospinal fluid fistulae (4.4%). In the NC DREZotomy group, mortality occurred in one patient (9%). There were two cases of transient ataxia (18%) and two of transient hemiparesis (18%).
Conclusion:
Spinal and trigeminal NC DREZ operations are effective in the treatment of intractable pain syndromes, especially in traumatic brachial plexus avulsions, segmental pain after spinal cord injury, postherpetic neuralgia, topographically limited cancer pain, and atypical facial pain.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Tuna
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Melih Bozkurt
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
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Tun K, Savas A, Sargon MF, Solaroglu I, Kanpolat Y. The histopathological and electron-microscopic examination of the stereotactic pulsed radiofrequency and conventional radiofrequency thermocoagulation lesions in rat brain. Neurol Res 2007; 28:841-4. [PMID: 17288742 DOI: 10.1179/016164106x110409] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Neurodestructive procedures have been used for treating intractable pain for a long time. Pulsed radiofrequency (RF) is a newly defined energy type. Pulsed RF may be used in the treatment of patients with some pain syndromes in whom the pain could not be controlled by the alternative techniques. The objective of the present study was to examine the histological and electron microscopical changes in rat brain after pulsed RF application. METHODS Forty-five male rats were used in these experiments. Lesions were applied stereotactically to the target areas of the rat brains. Two different RF energy type were used as representative models of pulsed-RF and conventional-RF procedures. The rats were kept alive for 21 days and then killed. The effect of pulsed RF lesions on cerebral tissue ultrastructure was studied. RESULTS In the pulsed RF group, intracytoplasmic edema, clarity of the mitochondrial cristas and opening in the cell membrane pores were observed on the electron microscopic examination. In the conventional RF group, these findings were more prominent. In the pulsed RF group, the ratio of the effected neurons was 5.5% on light microscopic examination. In the conventional RF group, the ratio of the effected neurons was 14.26% and central necrosis was observed additionally. DISCUSSION Pulsed RF caused ultrastructural changes in the neurons. The pulsed RF may possibly cause a depression on the cell membrane potential by opening the cell membrane pores and resulting in the ion entrance into the cell cytoplasm and intracytoplasmic edema. However, it seems that all these changes were reversible.
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Affiliation(s)
- Kagan Tun
- Department of Neurosurgery, Medical Faculty, Ankara University, Ankara, Turkey.
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Hong D, Andrén-Sandberg A. Punctate midline myelotomy: a minimally invasive procedure for the treatment of pain in inextirpable abdominal and pelvic cancer. J Pain Symptom Manage 2007; 33:99-109. [PMID: 17196911 DOI: 10.1016/j.jpainsymman.2006.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 06/27/2006] [Accepted: 06/27/2006] [Indexed: 10/23/2022]
Abstract
The midline of the dorsal column contains a pathway that may be more important for transmitting visceral nociceptive signals than the spinothalamic tract. Punctate midline myelotomy, a neuroablative operation with the intent of interrupting the midline of the dorsal column, has demonstrated efficacy in the treatment of otherwise intractable abdominal and pelvic cancer pain. The indications, technical procedure, outcomes, and complications of all published clinical studies of punctate midline myelotomy are reviewed. The lesion level of the spinal cord and the depth of the incision are discussed, with the focus on the feasibility of this technique.
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Affiliation(s)
- Dun Hong
- Department of Spine Surgery, Taizhou Hospital, Whenzhou University, Taizhou, China
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Kanpolat Y. Percutaneous destructive pain procedures on the upper spinal cord and brain stem in cancer pain: CT-guided techniques, indications and results. Adv Tech Stand Neurosurg 2007; 32:147-73. [PMID: 17907477 DOI: 10.1007/978-3-211-47423-5_6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In the century of science and technology, the average life span has increased, bringing with it an increase in the incidence of degenerative and cancer disease. Intractable pain is usually the main symptom of cancer. With the advancement in technology, there is a large group of patients with intractable pain problems who can benefit from special help medically or surgically. Destructive pain procedures are necessary to control the cancer pain and are based on the lesioning of the pain conducting pathways. Percutaneous cordotomy, trigeminal tractotomy and extralemniscal myelotomy are special methods based on lesioning of the pain conducting pathways. The procedure consists of obtaining direct morphological appearance of the upper spinal cord and surrounding structures by computed tomography (CT). The next step is functional evaluation of the target and its environment by impedance measurement and stimulation. The final step is terminated with controlled lesioning obtained by a radiofrequency system (generator, needles, electrode system). In the last two decades, CT-guided destructive procedures were used as minimally invasive procedures as follows: percutaneous cordotomy (207 patients), trigeminal tractotomy-nucleotomy (65 patients), and extralemniscal myelotomy (16 patients). Most of these patients had cancer pain. Minimally invasive CT-guided destructive pain procedures are still safe and effective operations for relieving intractable cancer pain in selected cases.
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Affiliation(s)
- Y Kanpolat
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
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13
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Rosen S. Percutaneous Cordotomy. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50178-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kanpolat Y, Savas A, Batay F, Sinav A. Computed tomography-guided trigeminal tractotomy-nucleotomy in the management of vagoglossopharyngeal and geniculate neuralgias. Neurosurgery 1998; 43:484-9; discussion 490. [PMID: 9733303 DOI: 10.1097/00006123-199809000-00045] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Vagoglossopharyngeal and geniculate neuralgias are less frequently seen types of cranial neuralgias. Their causes and symptomatology are similar to those of trigeminal neuralgia; however, the complex anatomic relationship between the intermedius, vagal, and glossopharyngeal nerves leads to difficulties in the diagnosis and management of neuralgias originating from these cranial nerves. Numerous procedures have been used to treat intractable neuralgias of the VIIth, IXth, and Xth cranial nerves: 1) extracranial sectioning of the cranial nerves, 2) percutaneous thermal rhizotomy, 3) intracranial glossopharyngeal and vagal rhizotomies, 4) microvascular decompression, and 5) percutaneous trigeminal tractotomy-nucleotomy (TR-NC) or nucleus caudalis dorsal root entry zone operation. We propose that computer-guided TR-NC may be the first-choice operation for patients with glossopharyngeal, vagal, or geniculate neuralgia. PATIENTS AND METHODS Nine patients suffering from idiopathic vagoglossopharyngeal neuralgia (six patients) and geniculate neuralgia (three patients) were managed at our clinic. Computed tomography-guided percutaneous trigeminal TR-NC was performed for these nine patients. RESULTS Excellent (six patients) or good (three patients) pain control was obtained in each patient. Complications included temporary ataxia in two patients after TR-NC. CONCLUSION The risk:benefit ratio should be evaluated individually to select the appropriate treatment procedure for patients with vagoglossopharyngeal and geniculate neuralgias. Computed tomography-guided percutaneous TR-NC is an effective and minimally invasive procedure for such patients.
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Affiliation(s)
- Y Kanpolat
- Department of Neurosurgery, Ankara University, School of Medicine, Turkey
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