Cordotomia percutanea

Ferreira, Nelson Pires; Azambuja, Ney A. V. De Castro

doi:10.1590/S0004-282X1980000100002

Resumos

São estudados os resultados obtidos em 47 cordotomias percutâneas realizadas em 43 pacientes. A técnica utilizada, os reparos anatômicos, o controle radiológico e o neurofisiológico são descritos e comentados. Não foi observada diferença nos resultados tendo como referência a duração e o tipo de dor, bem como a existência prévia de deficiência sensitiva. As complicações decorrentes da lesão medular são descritas e comparadas com as relatadas na literatura, observando-se resultados semelhantes. O estudo da casuística permite concluir que o método é útil, pouco traumático, podendo ser indicado em pacientes em mau estado geral. A realização da lesão, com o paciente acordado, oferece a vantagem de um controle mais preciso dos resultados imediatos.

The results obtained in 47 percutaneous cordotomies performed in 43 patients are reported. The methods used, the anatomic references, the radiologic and neurophysiology controls are described and commented. No diference was observed in the results if we consider the type and duration of the pre-existing pain, as well as the previous presence of sensory deficit. The benefits and complications of such form of treatment are described and compared with the ones presented in the literature, being equivalent. The study of this cases permit to conclude that this form of treatment is useful, causes little trauma and is well tolerated by patients in poor general conditions. The performance of the lesion with the patient awake adds the advantage of permitting a better control of the immediate results.

Cordotomia percutanea

Percutaneous cordotomies

Nelson Pires Ferreira^I; Ney A. V. De Castro Azambuja^II

^IProfessor-Adjunto e Livre-Docente de Neurocirurgia da Universidade Federal do Rio Grande do Sul

^IINeurocirurgião. Instituto de Neurocirurgia de Porto Alegre

RESUMO

São estudados os resultados obtidos em 47 cordotomias percutâneas realizadas em 43 pacientes. A técnica utilizada, os reparos anatômicos, o controle radiológico e o neurofisiológico são descritos e comentados. Não foi observada diferença nos resultados tendo como referência a duração e o tipo de dor, bem como a existência prévia de deficiência sensitiva. As complicações decorrentes da lesão medular são descritas e comparadas com as relatadas na literatura, observando-se resultados semelhantes. O estudo da casuística permite concluir que o método é útil, pouco traumático, podendo ser indicado em pacientes em mau estado geral. A realização da lesão, com o paciente acordado, oferece a vantagem de um controle mais preciso dos resultados imediatos.

SUMMARY

The results obtained in 47 percutaneous cordotomies performed in 43 patients are reported. The methods used, the anatomic references, the radiologic and neurophysiology controls are described and commented. No diference was observed in the results if we consider the type and duration of the pre-existing pain, as well as the previous presence of sensory deficit. The benefits and complications of such form of treatment are described and compared with the ones presented in the literature, being equivalent. The study of this cases permit to conclude that this form of treatment is useful, causes little trauma and is well tolerated by patients in poor general conditions. The performance of the lesion with the patient awake adds the advantage of permitting a better control of the immediate results.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado no Instituto de Neurocirurgia de Porto Alegre.

Instituto de Neurocirurgia - Pavilhão São José - Praça Dom Feliciano - 90000 Porto Alegre RS - Brasil.

1. BETTAG, W.; WANDT, H. & ROOSEN, K. - Pain treatment of advanced malignant diseases by higth cervical percutaneous cordotomy. In Advances in Neuro-surgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger, M. & Spoerri, O., ed. Springer-Verlag, Berlin, p. 186-189, 1975.
2. CLOWARD, R. B. - Cervical cordotomy by the anterior approach. J. Neurosurg. 21:19, 1964.
3. CRAWFORD, J. V. & WALKER, A. E. - Surgery for pain. In A History of Neurological Surgery - Walker, A. E., ed. Hafner Publishing, New York, cap. 13, p. 308-330, 1976.
4. ENTZIAN, W. & LINKE, D. - Experience with percutaneous cordotomy. In Advances in Neurosurgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger, M. & Spoerri, O., ed. Springer-Verlag, Berlin, p. 190-194, 1975.
5. FERREIRA, N. P.; AZAMBUJA, N. A. V. C. & WAGNER, R. C. - Cordotomia percutânea no tratamento da dor. Rev. AMRIGS (Porto Alegre) 20:235, 1976.
6. GUELMANN, J. M. - Comunicação pessoal.
7. LIN, P. M.; GILDENBERG, P. L. & POLAKOFF, P. P. - An anterior approach to percutaneous lower cervical cordotomy. J. Neurosurg. 25:553, 1966.
8. LORENZ, R.; GRUMME, T.; HERMANN, D.; PALLESKE, H.; KÜHNER, A.; STEUDE, U. & ZIEURSKI, J. - Percutaneous cordotomy. In Advances in Neurosurgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger, M. & Spoerri, O., ed. Springer-Verlag, Berlin, p. 178-185, 1975.
9. MAZARS, G. - État actuel de la chirurgie de la douleur. Neuro-Chirurgie (Paris) 22, suppl 1:41, 1976.
10. MÜKE, R. & CORREIA, A. - Cordotomia percutânea cervical. Arq. Neuro-Psiquiat. (São Paulo) 32:15, 1974.
11. MÜKE, R. & CORREIA, A. - Potentials and limits of percutaneous cervical cordotomy. In Advances in Neurosurgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger. M. & Spoerri, O., editors. Springer-Verlag, Berlin, p. 195, 1975.
12 MULLAN, J. F. - Percutaneous cordotomy - In Treatment of Pain - Voris. H. C. & Whisler, W. W., ed. Charles C. Thomas, Springfield (Illinois) p. 75, 1975.
13. MULLAN, S. - Percutaneous cordotomy. J. Neurosurg. 35:360, 1971.
14. MULLAN. S. - Percutaneous cordotomy (R. F.) - In Advances in Neurology Bonica, J. J., ed. Raven Press Pub., New York, p. 677, 1974.
15. MULLAN, S.; HARPER, P. V.; HEKMATEANAH, J.; TORRES, H. & DOBBEN, G. - Percutaneous interruption of spinal pain tracts by means of strontiun needle. J. Neurosurg. 20:931, 1963.
16. MULLAN, S.; HEKMATEANAH, J.; DOBBEN, G. & BECKMAN, F. - Percutaneous intramedulary cordotomy utilizing unipolar anodal electrolitic lesion. J. Neurosurg. 22:548, 1965.
17. MULLAN, S. & HOSOBUCHI, Y. - Respiratory hazards of higth cervical percutaneous cordotomy. J. Neurosurg. 28:291, 1968.
18. NATHAN, P. W. - The descending respiratory pathway in man. J. Neurol. Neurosurg. Psychiat. 26:487, 1963.
19. ONOFRIO, B. M. - Cervical spinal cord and dentate delineation in percutaneous radiofrequency cordotomy at the level of the first to second cervical vertebrae. Surg. Gyn. Obstet. 133:30, 1971.
20. ROSOMOFF, H. L. - Bilateral percutaneous cervical radiofrequency cordotomy. J. Neurosurg. 31:41, 1969.
21. ROSOMOFF, H. L. - Percutaneous radiofrequency cervical cordotomy for intractable pain. In Advances in Neurology 4. - Bonica, J. J., ed. Raven Press Pub., New York, p. 683, 1974.
22. ROSOMOFF, H. L.; CARROL, F.; BROWN, J. & SHEPTAK, P. - Percutaneous radiofrequency cervical cordotomy technique. J. Neurosurg. 23:639, 1965.
23. SPILLER, W. G. & MARTIN, E. - The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord. J. A. M. A. 20:1489, 1912.
24. SWEET, W. H. - Recent observations pertinent to improving anterolateral cordotomy. Clin. Neurosurg. 23:80, 1976.
25. TAREN, J. A.; DAVIS, R. & CROSBY, E. C. - Target physiologic corroboration in stereotaxic cervical cordotomy. J. Neurosurg. 30:569, 1969.
26. TASKER, R. R.; ORGAN, L. W. & SMITH, K. C. - Physiological guidlines for localization of lesions by percutaneous cordotomy. In Acta Neurochirurgia - Advances in Stereotatic and Functional Neurosurgery - Guillingham, F. J.: Hitchcock, E. R. & Turner. J. W., ed. Springer-Verlag, Berlin. Suppl. 21, p. 111. 1974.
27. TASKER, R. R. - Open cordotomy. In Progress in Neurological Surgery: Pain Its Neurological Management, Part II: Central Procedures - Krayenbuhl, H.: Maspes, P. E. & Sweet, W. H., ed. S. Karger. Basel, vol. 8, p. 1-13. 1977.
28. WHITE, J. C. & SWEET, W. H. - Pain and Neurosurgeon. Charles C. Thomas Pub., Springfield (Illinois), p. 678, 1969.

Datas de Publicação

Publicação nesta coleção
22 Ago 2012
Data do Fascículo
Mar 1980

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BETTAG, W.; WANDT, H. & ROOSEN, K. - Pain treatment of advanced malignant diseases by higth cervical percutaneous cordotomy. In Advances in Neuro-surgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger, M. & Spoerri, O., ed. Springer-Verlag, Berlin, p. 186-189, 1975.

[2] 2. CLOWARD, R. B. - Cervical cordotomy by the anterior approach. J. Neurosurg. 21:19, 1964.

[3] 3. CRAWFORD, J. V. & WALKER, A. E. - Surgery for pain. In A History of Neurological Surgery - Walker, A. E., ed. Hafner Publishing, New York, cap. 13, p. 308-330, 1976.

[4] 4. ENTZIAN, W. & LINKE, D. - Experience with percutaneous cordotomy. In Advances in Neurosurgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger, M. & Spoerri, O., ed. Springer-Verlag, Berlin, p. 190-194, 1975.

[5] 5. FERREIRA, N. P.; AZAMBUJA, N. A. V. C. & WAGNER, R. C. - Cordotomia percutânea no tratamento da dor. Rev. AMRIGS (Porto Alegre) 20:235, 1976.

[6] 6. GUELMANN, J. M. - Comunicação pessoal.

[7] 7. LIN, P. M.; GILDENBERG, P. L. & POLAKOFF, P. P. - An anterior approach to percutaneous lower cervical cordotomy. J. Neurosurg. 25:553, 1966.

[8] 8. LORENZ, R.; GRUMME, T.; HERMANN, D.; PALLESKE, H.; KÜHNER, A.; STEUDE, U. & ZIEURSKI, J. - Percutaneous cordotomy. In Advances in Neurosurgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger, M. & Spoerri, O., ed. Springer-Verlag, Berlin, p. 178-185, 1975.

[9] 9. MAZARS, G. - État actuel de la chirurgie de la douleur. Neuro-Chirurgie (Paris) 22, suppl 1:41, 1976.

[10] 10. MÜKE, R. & CORREIA, A. - Cordotomia percutânea cervical. Arq. Neuro-Psiquiat. (São Paulo) 32:15, 1974.

[11] 11. MÜKE, R. & CORREIA, A. - Potentials and limits of percutaneous cervical cordotomy. In Advances in Neurosurgery 3: Brain Hypoxia; Pain - Penzholz, H.; Brock, M.; Hamer, J.; Klinger. M. & Spoerri, O., editors. Springer-Verlag, Berlin, p. 195, 1975.

[12] 12 MULLAN, J. F. - Percutaneous cordotomy - In Treatment of Pain - Voris. H. C. & Whisler, W. W., ed. Charles C. Thomas, Springfield (Illinois) p. 75, 1975.

[13] 13. MULLAN, S. - Percutaneous cordotomy. J. Neurosurg. 35:360, 1971.

[14] 14. MULLAN. S. - Percutaneous cordotomy (R. F.) - In Advances in Neurology Bonica, J. J., ed. Raven Press Pub., New York, p. 677, 1974.

[15] 15. MULLAN, S.; HARPER, P. V.; HEKMATEANAH, J.; TORRES, H. & DOBBEN, G. - Percutaneous interruption of spinal pain tracts by means of strontiun needle. J. Neurosurg. 20:931, 1963.

[16] 16. MULLAN, S.; HEKMATEANAH, J.; DOBBEN, G. & BECKMAN, F. - Percutaneous intramedulary cordotomy utilizing unipolar anodal electrolitic lesion. J. Neurosurg. 22:548, 1965.

[17] 17. MULLAN, S. & HOSOBUCHI, Y. - Respiratory hazards of higth cervical percutaneous cordotomy. J. Neurosurg. 28:291, 1968.

[18] 18. NATHAN, P. W. - The descending respiratory pathway in man. J. Neurol. Neurosurg. Psychiat. 26:487, 1963.

[19] 19. ONOFRIO, B. M. - Cervical spinal cord and dentate delineation in percutaneous radiofrequency cordotomy at the level of the first to second cervical vertebrae. Surg. Gyn. Obstet. 133:30, 1971.

[20] 20. ROSOMOFF, H. L. - Bilateral percutaneous cervical radiofrequency cordotomy. J. Neurosurg. 31:41, 1969.

[21] 21. ROSOMOFF, H. L. - Percutaneous radiofrequency cervical cordotomy for intractable pain. In Advances in Neurology 4. - Bonica, J. J., ed. Raven Press Pub., New York, p. 683, 1974.

[22] 22. ROSOMOFF, H. L.; CARROL, F.; BROWN, J. & SHEPTAK, P. - Percutaneous radiofrequency cervical cordotomy technique. J. Neurosurg. 23:639, 1965.

[23] 23. SPILLER, W. G. & MARTIN, E. - The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord. J. A. M. A. 20:1489, 1912.

[24] 24. SWEET, W. H. - Recent observations pertinent to improving anterolateral cordotomy. Clin. Neurosurg. 23:80, 1976.

[25] 25. TAREN, J. A.; DAVIS, R. & CROSBY, E. C. - Target physiologic corroboration in stereotaxic cervical cordotomy. J. Neurosurg. 30:569, 1969.

[26] 26. TASKER, R. R.; ORGAN, L. W. & SMITH, K. C. - Physiological guidlines for localization of lesions by percutaneous cordotomy. In Acta Neurochirurgia - Advances in Stereotatic and Functional Neurosurgery - Guillingham, F. J.: Hitchcock, E. R. & Turner. J. W., ed. Springer-Verlag, Berlin. Suppl. 21, p. 111. 1974.

[27] 27. TASKER, R. R. - Open cordotomy. In Progress in Neurological Surgery: Pain Its Neurological Management, Part II: Central Procedures - Krayenbuhl, H.: Maspes, P. E. & Sweet, W. H., ed. S. Karger. Basel, vol. 8, p. 1-13. 1977.

[28] 28. WHITE, J. C. & SWEET, W. H. - Pain and Neurosurgeon. Charles C. Thomas Pub., Springfield (Illinois), p. 678, 1969.