Computed Tomography-Guided Percutaneous Cordotomy

摘要

1The authors are to be complimented on the excellent results they obtained with computed tomography-guided percutaneous cordotomy for intractable pain and malignancy. The technique and results are exceptional and the article provides a detailed description of the procedure, contraindications, patient selection and other factors.Open cordotomy was only briefly mentioned; however, some advantages of the open procedure are the fact that with today's technology the patient can have a small midline incision over T2 with a minimally invasive laminectomy performed. Using a neurosurgical microscope, the dentate ligament is divided and the cord gently rotated by grasping the dentate ligament to expose the anterolateral white matter. Bleeding is usually minimal once the vessels on the surface of the spinal cord are controlled. The dura and arachnoid are sutured to avoid leak and the incision closed; the patient may have aching around the incision for a few days. No radiofrequency probe and no radiofrequency current generator are required for the open procedure. Some frail patients may have less stress with a general anesthetic compared with being awake and receiving intermittent sedation as in a percutaneous procedure. Bleeding and spinal cord swelling potentially may be more controlled using an open procedure compared with a percutaneous procedure.Bilateral high cervical percutaneous cordotomy is contraindicated because it has been associated with Ondine's curse, an uncommon potentially fatal complication involving respiratory arrest, although Kanpolat et al. have reported success by delaying the second side by 1 week.