Computer-assisted DREZ microcoagulation: posttraumatic spinal deafferentation pain.

Our data demonstrate that approximately 23-29% of standard dorsal root entry zone (DREZ) microcoagulation procedures fail to relieve pain due to inadequate thermal lesions and that approximately 39% fail due to insufficient superior extent of lesions. The remaining failures are related to inadequate lesion placement, improper selection of patients, and, rarely, posttraumatic spinal deafferentation pain resulting from other non-DREZ mechanisms. Computer-assisted DREZ microcoagulation is a satisfactory procedure to treat intractable posttraumatic spinal deafferentation pain, brachial plexus avulsion pain, and lumbosacral nerve root avulsion pain. In all these conditions we have identified areas of abnormal focal hyperactivity in the DREZ area. Perhaps this procedure can be applied to other central pain conditions if, using this technique, abnormal focal hyperactivity is demonstrated to be present.

Progressive posttraumatic cystic myelopathy: neuroradiologic evaluation.

The neuroradiologic evaluation and findings in 25 symptomatic patients with surgically proven progressive posttraumatic cystic myelopathy are reviewed. To follow patients with spinal cord injury, neuroradiologic algorithms were developed to confirm and define cystic myelopathy. The algorithm used in the early and mid 1970s relied on the myelographic demonstration of a large cord for suspicion of a cyst. Review of this material found that in progressively symptomatic patients 14 of 25 proven cysts were in large cords. A more recent algorithm used computed tomographic metrizamide myelography. In nine of 11 patients studied in this fashion, the cyst filled with contrast material 2--4 hr after injection, yet it did not communicate with the subarachnoid space at subsequent surgery. The origin of the cyst fluid and mechanism of cyst demonstration with metrizamide may be associated with transneural migration of fluid. This condition must be clinically suspected and radiologically confirmed for surgical treatment (cyst-shunt procedure) if neurologic preservation of function is to be maintained.

Colloid cyst causing rhinorrhea.

A case of nontraumatic cerebrospinal fluid (CSF) rhinorrhea secondary to obstruction of the flow of cerebrospinal fluid by a colloid cyst is reported. Only 1 other case of CSF rhinorrhea secondary to a colloid cyst has been reported. A review of the world literature reveals 33 cases of CSF rhinorrhea secondary to obstruction of flow of cerebrospinal fluid.

Surgical management of spinal cord cysts.

A new surgical method, myelocyst-peritoneal shunt, has been performed on a small series of patients with congenital and acquired spinal cord cysts. In all cases, the progressive deterioration of neurological function ceased and all patients had slight to significant objective and/or subjective improvement in neurological function. The technical method is described along with individual case reports. Due to the short length of follow-up, the small number of operations, and the tendency for spinal cord cysts to spontaneously improve, the author discussed only potential advantages and disadvantages of this procedure as compared to prior spinal cord cyst operations. The creation of an in vitro human module spinal cord cyst by means of this operation has made it possible for the author to perform more basic ongoing investigation into the pathophysiology of spinal cord cysts and other similar disorders.