Pain

2016 ◽  
pp. 75-90
Author(s):  
Konstantin V. Slavin
Keyword(s):  
Dorsal Root ◽  
Pain Syndrome ◽  
Board Examination ◽  
Entry Zone ◽  
The Core ◽  
Root Entry Zone ◽  
Refractory Pain ◽  
Pain Syndromes ◽  
Pain Pump ◽  
Neurosurgical Education

Historically, surgery for pain has been a large part of general neurosurgical practice. A variety of destructive and decompressive interventions have been developed over the years, and a number of comprehensive textbooks have summarized neurosurgical involvement with management of all kinds of medically refractory pain syndromes. It is included in the core neurosurgical education curriculum and is an integral part of neurosurgical knowledge that is tested during the Oral Board Examination. Not surprisingly, cases involving complex pain conditions that require neurosurgical interventions routinely show up during examinations, and it is expected that examinees are comfortable performing these interventions and able to discuss indications, surgical details, outcomes, and complications. Cases include trigeminal neuralgia, plexopathy, cordotomy versus morphine pain pump for cancer pain, dorsal root entry zone myelotomy for brachial plexus avulsion, and complex regional pain syndrome.

scholarly journals Microsurgical DREZ lesions for the control of cancer-related pain

2020 ◽  
Vol 3 (2) ◽  
pp. V14 ◽  
Author(s):  
Edoardo Mazzucchi ◽  
Andrei Brinzeu ◽  
Patrick Mertens ◽  
Marc Sindou
Keyword(s):  
General Condition ◽  
Dorsal Root ◽  
Lateral Part ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Patients With Cancer ◽  
Root Entry Zone ◽  
Refractory Pain ◽  
Pain Pathways ◽  
Good General Condition

Pain in patients with cancer is a major problem, and sometimes it is necessary to surgically interrupt pain pathways to effectively control refractory pain. Surgical lesion of the dorsal root entry zone (DREZ) was first performed in 1972 for the treatment of pain related to a Pancoast-Tobias tumor. The rationale of DREZotomy is to preferentially interrupt the nociceptive inputs in the lateral part of the DREZ and the ventrolateral (excitatory) part of the dorsal horn. Microsurgical DREZotomy is one technique for DREZ lesioning that is suited for tailored control of pain in patients in good general condition who are experiencing pain in a well-defined territory.The video can be found here: https://youtu.be/JtLQDP7gYSQ

scholarly journals Central Neuropathic Pain and Complex Regional Pain Syndrome Following Brachial Plexus Injury Treated Successfully With Dorsal Root Entry Zone Lesioning

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Reda Tolba ◽  
Maged Guirguis ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Root ◽  
Brachial Plexus Injury ◽  
Pain Syndrome ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Central Neuropathic Pain ◽  
Root Entry Zone

Abstract INTRODUCTION Central neuropathic pain (CNP) and complex regional pain syndrome (CRPS) present as chronic, unrelenting, and disabling pain resulting from central and peripheral nervous system injuries. For patients who have failed conservative management, dorsal root entry zone (DREZ) lesioning may serve as an alternative for the management of intractable pain. METHODS A 36-yr-old male presented with complete right brachial plexus injury and avulsion of nerve roots following a motorcycle accident. He developed disabling type I CRPS of the right upper extremity. After failing medical therapy, he underwent a trial of conventional SCS using 2 percutaneous leads in the upper cervical spine but did not get topographical coverage. He underwent a second SCS trial with the placement of a paddle lead using burst therapy, but his initial partial pain relief subsided after 3 d. Subsequently, he underwent SCS removal, C2 to T1 right DREZ lesioning, and C4 to T1 laminoplasty. The patient gained a significant pain relief and became more functional. Five months postoperatively, he experienced an improvement in his pain and narcotic consumption. RESULTS Using an insulated neurotomy electrode, 2-mm-deep lesions were made at 75°C for 15 s. A total of 83 lesions were made from T2 to C3. Each lesion was spaced 1 mm apart. The impedance was less than 1000 ohms, which was consistent within an area of injury. Somatosensory and motor-evoked potentials were at baseline during the case without significant changes. CONCLUSION When SCS fails, lesioning of the dorsal root entry zone is a useful tool in the armamentarium for the management of refractory brachial plexus neuropathic pain.

Efficacy and factors determining the outcome of dorsal root entry zone lesioning procedure (DREZotomy) in the treatment of intractable pain syndrome

2017 ◽  
Vol 159 (12) ◽  
pp. 2431-2442 ◽  
Author(s):  
Nontaphon Piyawattanametha ◽  
Bunpot Sitthinamsuwan ◽  
Pramote Euasobhon ◽  
Nantthasorn Zinboonyahgoon ◽  
Pranee Rushatamukayanunt ◽  
...  
Keyword(s):  
Dorsal Root ◽  
Pain Syndrome ◽  
Intractable Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone

Thermocoagulation of the Dorsal Root Entry Zone for the Treatment of Intractable Pain

Neurosurgery ◽  
1984 ◽  
Vol 15 (6) ◽  
pp. 953-955 ◽  
Author(s):  
Madjid Samii ◽  
Jean Richard Moringlane
Keyword(s):  
Dorsal Root ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Phantom Limb ◽  
Intractable Pain ◽  
Limb Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Peripheral Nerve Lesions

Abstract The authors report the results of DREZ thermocoagulation in 35 patients since March 1980. This technique was applied not only in patients with deafferentation pain after brachial plexus avulsion, but also for postamputation phantom limb pain and pain caused by injury to the spine and spinal cord, by peripheral nerve lesions, and by multiple sclerosis. Independent of etiology, the duration of the pain syndrome, and the quality and projection of the pain, the overall results have been satisfactory and long-lasting.

Epilepsy, Functional, and Pain Neurosurgery

2020 ◽  
pp. 139-160
Author(s):  
Nitin Tandon ◽  
Konstantin V. Slavin
Keyword(s):  
Hippocampal Sclerosis ◽  
Brain Lesion ◽  
Temporal Lobectomy ◽  
Refractory Pain ◽  
Pain Syndromes ◽  
Epileptogenic Lesion ◽  
Pain Pump ◽  
Eloquent Cortex ◽  
Mapping Language ◽  
Neurosurgical Education

This chapter covers several aspects of the management of seizures and epilepsy relevant to a general neurosurgical practice. First, all candidates should know how to manage a patient presenting with a new-onset seizure or in status epilepticus with a brain lesion or after a craniotomy. Second, they are expected to be able to explain how to perform fundamental epilepsy procedures such as a temporal lobectomy for hippocampal sclerosis or resection of an epileptogenic lesion. Third, it is useful to have a clear process in place for mapping language and motor function for the resection of tumors located in the eloquent cortex. Lastly, the thought process behind developing an appropriate plan for the surgical management of movement disorders and the technical nuances of managing such cases are discussed. Historically, surgery for pain has been a large part of general neurosurgical practice. A variety of destructive and decompressive interventions have been developed over the years, and a number of comprehensive textbooks have summarized neurosurgical involvement with management of all kinds of medically refractory pain syndromes. It is included in the core neurosurgical education curriculum and is an integral part of neurosurgical knowledge that is tested during the oral board examination. Not surprisingly, cases involving complex pain conditions that require neurosurgical interventions may show up during examinations, and it is expected that examinees are comfortable performing these interventions and able to discuss indications, surgical details, outcomes and complications. Cases include trigeminal neuralgia, cordotomy versus morphine pain pump for cancer pain and a spinal cord stimulator.

Treatment of Refractory Pain after Brachial Plexus Avulsion with Dorsal Root Entry Zone Lesions

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1269-1277 ◽  
Author(s):  
Madjid Samii ◽  
Steffani Bear-Henney ◽  
Wolf Lüdemann ◽  
Marcos Tatagiba ◽  
Ulrike Blömer
Keyword(s):  
Brachial Plexus ◽  
Dorsal Root ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Brachial Plexus Avulsion ◽  
Root Entry Zone ◽  
Refractory Pain

scholarly journals Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion: A Comprehensive Literature Review

2021 ◽  
Author(s):  
Axumawi Mike Hailu Gebreyohanes ◽  
Aminul Islam Ahmed ◽  
David Choi
Keyword(s):  
Brachial Plexus ◽  
Patient Outcomes ◽  
Dorsal Root ◽  
Cervical Spinal Cord ◽  
Entry Zone ◽  
Neurosurgical Procedure ◽  
Dorsal Root Entry Zone ◽  
Brachial Plexus Avulsion ◽  
Root Entry Zone ◽  
Comprehensive Literature Review

Abstract Dorsal root entry zone (DREZ) lesioning is a neurosurgical procedure that aims to relieve severe neuropathic pain in patients with brachial plexus avulsion by selectively destroying nociceptive neural structures in the posterior cervical spinal cord. Since the introduction of the procedure over 4 decades ago, the DREZ lesioning technique has undergone numerous modifications, with a variety of center- and surgeon-dependent technical differences and patient outcomes. We have reviewed the literature to discuss reported methods of DREZ lesioning and outcomes.

Sign in / Sign up

Export Citation Format

Share Document