CT-guided percutaneous Selective Cordotomy

Background: Pain is often one of the most debilitating symptoms in patients with advanced oncological disease. Patients with localized pain due to malignancy refractory to medical treatment can benefit from selective percutaneous cordotomy that disconnects the ascending pain fibers in the spinothalamic tract. Objectives: Over the past year, we have been performing percutaneous radiofrequency cordotomy with the use of the O-Arm intraoperative imaging system that allows both 2D fluoroscopy and 3D reconstructed computerized tomography imaging. We present our experience using this technique, focusing on technical nuances and complications. Methods: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy between March 2016 and March 2017. Results: Nineteen patients underwent percutaneous cordotomy procedures. Two patients developed intraoperative delirium and were unable to tolerate the procedure. In 16 out of 17 completed procedures, we achieved excellent immediate pain relief (94%). At 1 month after operation, 15 of the 17 (88%) patients were pain free, and at 3 months 5 out of 5 patients available for follow-up were still free of their original pain. Mirror pain developed in 6 of the 17 patients (35%), but was mild in 4 of these cases and controlled with medications. We experienced 1 serious complication (6%) of ipsilateral hemiparesis. Conclusion: Percutaneous cordotomy using the O-Arm is safe and effective in the treatment of intractable oncological pain.

Section: Introductionmentioning

confidence: 99%

O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Strauss

Berger²,

Arad

et al. 2017

“…In addition to improvements in lesioning technique, the procedure was advanced through myelography to outline the spinal cord, electrical impedance monitoring of needle penetration, and the use of physiological confirmation of electrode position in awake patients [18,19,20,21,22,23,24,25,26]. Most recently, Kanpolat et al [7,15,27] introduced computed tomographic (CT)-guided percutaneous cordotomy, which has greatly enhanced the safety and efficacy of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Four-Decade Maintenance of Analgesia with Percutaneous Cordotomy

Collins¹,

Taren²,

Patil³

2012

The management of severe, medically intractable pain is a significant challenge for neurosurgeons and pain management physicians. An existing technique that can effectively alleviate contralateral chronic pain is cordotomy, interruption of the lateral spinothalamic tract of the spinal cord. Since 1912, cordotomy has evolved from a relatively morbid open surgical procedure to a percutaneous radiofrequency procedure with low morbidity. However, since cordotomy is utilized primarily in cancer pain patients, long-term patient follow-up is rare, and the potential duration of analgesia following cordotomy is not known. Here we describe a case with a 41-year follow-up of percutaneous cordotomy for noncancer pain that resulted in over 35 years of complete analgesia, the longest recorded in the literature to date. This case demonstrates that percutaneous cordotomy can provide long-lasting, complete analgesia in some patients and merits continuation as a part of the neurosurgical arsenal of pain therapies.

“…The introduction of CT-guided PCC demonstrated that the application of advanced radiographic techniques could increase the precision of PCC [5]. However, CT guidance for PCC is often not utilized due to the cumbersome nature of the equipment and lack of availability of intraoperative CT scanners.…”

Section: Discussionmentioning

confidence: 99%

“…Since its original description in 1962, electrode placement has been based on the visualization of the dentate ligament using lateral intraoperative fluoroscopic myelography, CSF flow through the introducing needle, and changes in tissue impedance [1][2][3][4]. CT guidance has been the only significant advancement in PCC in the past quarter century [5].…”

Section: Introductionmentioning

confidence: 99%

MRI-Guided Frameless Stereotactic Percutaneous Cordotomy

McGirt

Villavicencio²,

Bulsara³

et al. 2002

Background: Use of intraoperative myelography as a radiologic guidance for percutaneous cervical cordotomy (PCC) has been superseded by more modern imaging. The only significant advancement in cordotomy techniques over the last 30 years has been CT-guided PCC. The goal of this study was to demonstrate the feasibility of an MRI-guided frameless technique in high cervical cordotomy. Methods: We describe 6 patients with intractable pain treated using a frameless, MRI-guided, stereotactic, PCC technique in combination with standard physiological localization procedures. Results were compared with those from 32 patients who underwent PCC in the last 5 years using physiological localizing techniques only. Results: Six patients (100%) who underwent the frameless technique had excellent pain relief postoperatively. Patients in the non-stereotactic group, on average, required a higher number of lesions (2.5 vs. 1.2, p < 0.005), and 7 (22%) of these patients had unsatisfactory pain relief following PCC (p = 0.21). Five patients in the non-stereotactic group had weakness postoperatively and 1 had changes in bladder function. Postoperative weakness occurred in 1 patient undergoing the frameless technique. At an average of 6 months of follow-up (range 5–11), excellent pain relief was achieved in 83% (5/6) of MRI frameless PCC patients and 55% (16/29) of standard PCC patients (p = 0.20). Conclusions: Intraoperative frameless stereotaxy provides surgeons with accurate information that helps to guide the operative approach and precisely tailor the trajectory and depth of the electrode, potentially increasing the safety and efficacy of the operation.