Endoscopic-guided percutaneous radiofrequency cordotomy

2010 ◽  
Vol 113 (3) ◽  
pp. 524-527 ◽  
Author(s):  
Erich Talamoni Fonoff ◽  
Ywzhe Sifuentes Almeida de Oliveira ◽  
William Omar Contreras Lopez ◽  
Eduardo Joaquim Lopes Alho ◽  
Nilton Alves Lara ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Vessels ◽  
Cervical Spinal Cord ◽  
Ventral Root ◽  
Csf Leak ◽  
Clinical Implementation ◽  
Guide Cannula ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Dentate Ligament

The authors present the first clinical implementation of an endoscopic-assisted percutaneous anterolateral radiofrequency cordotomy. The aim of this article is to demonstrate the intradural endoscopic visualization of the cervical spinal cord via a percutaneous approach to refine the spinal target for anterolateral cordotomy, avoiding undesired trauma to the spinal tissue or injury to blood vessels. Initially, a lateral puncture of the spinal canal in the C1–2 interspace is performed, guided by fluoroscopy. As soon as CSF is reached by the guide cannula (17-gauge needle), the endoscope can be inserted for visualization of the spinal cord and its surrounding structures. The endoscopic visualization provided clear identification of the pial surface of the spinal cord, arachnoid membrane, dentate ligament, dorsal and ventral root entry zone, and blood vessels. The target for electrode insertion into the spinal cord was determined to be the midpoint from the dentate ligament and the ventral root entry zone. The endoscopic guidance shortened the fluoroscopy usage time and no intrathecal contrast administration was needed. Cordotomy was performed by a standard radiofrequency method after refining of the neurophysiological target. Satisfactory analgesia was provided by the procedure with no additional complications or CSF leak. The initial use of this technique suggests that a percutaneous endoscopic procedure may be useful for particular manipulation of the spinal cord, possibly adding a degree of safety to the procedure and improving its effectiveness.

scholarly journals C1-C3 unilateral dorsal root entry zone rhizotomy for the treatment of persistent postherpetic occipital neuralgia

2019 ◽  
Vol 10 ◽  
pp. 214
Author(s):  
Zaid Aljuboori ◽  
Joseph Neimat
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Cervical Spinal Cord ◽  
New Left ◽  
Occipital Neuralgia ◽  
Invasive Treatment ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone

Background: Postherpetic occipital neuralgia (PHON) is a neuropathic pain condition that usually presents as paroxysmal pain that is stabbing in nature.[5,7] It involves the occiput and posterior scalp in the distribution of the greater and/or lesser occipital nerves. It usually develops after an episode of shingles.[5,7] Treatment usually first consists of medical therapy and then progresses to invasive treatment (e.g., peripheral nerve stimulation, spinal cord epidural stimulation, C2-C3 ganglionectomy, or dorsal root entry zone [DREZ] rhizotomy).[1-4,6] Here, we present a case of persistent PHON that was treated with C1-C3 DREZ. Case Description: A 37-year-old female had a history of several episodes of shingles involving the left neck and occiput; they resolved after treatment with valacyclovir. Subsequently, however, she developed severe lancinating pain of the neck and the occiput and was diagnosed with PHON. Initially, she was treated with oxcarbazepine but was stopped due to cognitive side effects. She then had a cervical spinal cord stimulator implanted which produced relief for several years; it was later removed due to breakage of the electrodes. She then underwent a left- sided C1-C2 hemilaminectomy with a C1-C3 DREZ procedure.[1] Postoperatively, she had immediate resolution of her pain, but developed a new left hemiparesis (4+/5), accompanied by imbalance, decreased sensation to light touch, and loss of proprioception. On 6 weeks follow up, the pain was still relieved, and she exhibited significant improvement in her left-sided hemiparesis and hemisensory deficit to which returned to baseline. Similar outcome was maintained at four months follow up. Conclusion: Although high cervical DREZ lesions may effectively treat post herpetic/occipital neuralgia that fails other measures, there may be associated major neurological morbidity that makes this procedure acceptable as a salvage option, and after clearly explaining the risks to the patient.

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.

Spinal cord mapping with evoked responses for accurate localization of the dorsal root entry zone

1995 ◽  
Vol 82 (4) ◽  
pp. 587-591 ◽  
Author(s):  
Mahmood Fazl ◽  
David A. Houlden ◽  
Zelma Kiss
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Neurological Deficits ◽  
Intractable Pain ◽  
Specific Stimulus ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Accurate Localization

✓ Direct spinal cord stimulation and recording techniques were used intraoperatively to localize the dorsal root entry zone (DREZ) in four patients with brachial plexus avulsion and severe intractable pain. The spinal cord was stimulated by a cordotomy needle placed on the pia-arachnoid at the DREZ or the dorsal or dorsolateral aspect of the spinal cord. Recordings were obtained from a subdural silver ball electrode placed rostral or caudal to the stimulation site. Spinal cord conduction velocity was significantly faster following dorsolateral stimulation than dorsal stimulation (mean = 66 and 45 m/sec respectively). The spinal cord evoked potential was significantly larger in amplitude following dorsolateral stimulation than dorsal stimulation at a specific stimulus intensity. Stimulation at the DREZ failed to evoke a response. These neurophysiological phenomena helped to accurately localize the DREZ before DREZ lesioning was undertaken. There were no untoward neurological deficits related to the DREZ lesions and all patients had satisfactory pain relief following the procedure. Intraoperative spinal cord mapping facilitates accurate DREZ localization when the DREZ cannot be visually identified.

The fine anatomy of the human spinal meninges

1988 ◽  
Vol 69 (2) ◽  
pp. 276-282 ◽  
Author(s):  
David S. Nicholas ◽  
Roy O. Weller
Keyword(s):  
Spinal Cord ◽  
Blood Vessels ◽  
Transverse Section ◽  
Human Cerebral Cortex ◽  
Pia Mater ◽  
Content Type ◽  
Inner Aspect ◽  
Dentate Ligament ◽  
Arachnoid Mater ◽  
Fine Print

✓ The fine anatomy of the human spinal meninges was examined in five postmortem spinal cords taken within 12 hours after death from patients aged 15 months to 46 years. Specimens of spinal cord were viewed in transverse section and from the dorsal and ventral aspects by scanning electron microscopy. Transverse sections of spinal cord and meninges were also examined by light microscopy. The arachnoid mater was seen to be closely applied to the inner aspect of the dura. An intermediate fenestrated leptomeningeal layer was observed attached to the inner aspect of the arachnoid mater and was reflected ventrally to form a series of dorsal septa. As it arborized laterally over the surface of the cord to surround nerves and blood vessels, the intermediate layer became highly fenestrated but remained distinct from the pia and arachnoid mater. The pia mater appeared to form a continuous layer which was reflected off the surface of the cord to coat blood vessels within the subarachnoid space in a manner similar to that described in the leptomeninges over the human cerebral cortex. Each dentate ligament consisted of a collagenous core which was continuous with the subpial connective tissue and was attached at intervals to the dura; pia-arachnoid cells coated the surface of the dentate ligaments. The present study suggests that the fine anatomy of the human spinal meninges differs significantly from that described in other mammals.

scholarly journals Neurosurgical treatment of pain

2006 ◽  
Vol 59 (9-10) ◽  
pp. 450-455
Author(s):  
Eugen Slavik
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Surgical Treatment ◽  
Spinal Cord Stimulation ◽  
Dorsal Root ◽  
Neurosurgical Procedures ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Deep Brain

Introduction. Surgical treatment of chronic pain includes destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative, and accompanied by high morbidity and mortality rates. Surgical treatment of pain. During the past three decades, thanks to current knowledge on chronic pain mechanisms and technological developments, such as improved microsurgical and stereotactic techniques, guided by computerized tomography, magnetic resonance imaging and neural tissue impedance monitoring, the majority of ablative procedures have been replaced by new methods. Among them, a few can be considered as selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone lesions, limited midline myelotomy) and others as neuroaugumentative procedures for neuromodulatory processes (deep brain structures and spinal cord stimulation, drug-delivery systems). Neurosurgical procedures. Cordotomy is very effective in pain treatment and it may produce complete abolishment of pain, especially in patients suffering from neoplastic invasion of the brachial plexus (Pancoast?s syndrome) or lumbosacral plexus. Dorsal root entry zone operation is generally the only treatment option for pain due to root avulsion and segmental pain in spinal cord injury. Spinal cord stimulation is useful in management of pain following peripheral nerve injury. Deep brain stimulation is a promising treatment of central pain. Conclusion. The purpose of this review is to draw attention to neurosurgical approaches to treatment of chronic and opioid-resistant pain. .

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