RESUMO
Cancer is a systemic and progressive disease, and pain is a serious problem for patients. Cordotomy is one of the most effective treatments for refractory cancer pain. Bilateral percutaneous cervical cordotomy can be performed in patients with bilateral extremity pain. Accordingly, this case report discusses the use of bilateral cervical percutaneous cordotomy in the treatment of refractory cancer pain based on a 69-year-old woman with soft tissue sarcoma.
Assuntos
Dor do Câncer , Cordotomia , Humanos , Feminino , Idoso , Dor do Câncer/cirurgia , Sarcoma/cirurgia , Sarcoma/complicações , Medição da Dor , Dor Intratável/cirurgia , Diagnóstico DiferencialRESUMO
OBJECTIVE: To describe a novel surgical approach in which myelotomy was performed lateral to the dorsal root entry zone (LDREZ), for the treatment of lateral or ventrolateral spinal intramedullary glioma. METHODS: This study reviewed six patients with lateral or ventrolateral spinal intramedullary glioma who received surgical treatments by using myelotomy technique of LDREZ approach. The patient's clinical characteristics, magnetic resonance imaging (MRI) results, and follow-up outcomes were analyzed. The neurological function of patients before and after operation was assessed based on the Frankel scale system. The anatomical feasibility, surgical techniques, advantages and disadvantages of LDREZ approach were analyzed. RESULTS: Myelotomy technique of LDREZ approach was employed in all 6 patients. Gross total resections were achieved in 4 patients, and 2 patients with astrocytoma (case 2, 6) underwent partial removal. The perioperative recovery was all smooth and all the patients were discharged on schedule. All the patients who suffered from neuropathic pain were relieved. After surgery, neurological function remained unchanged in 3 patients. 2 patients improved from Frankel grade B to C, and 1 patient deteriorated from Frankel grade D to C immediately after surgery and returned to Frankel grade D at 3 months follow-up. Regarding to the poor prognosis of high-grade glioma, the two cases with WHO IV glioma didn't achieve long survival. CONCLUSION: LDREZ approach is feasible and safe for the surgical removal of lateral or ventrolateral spinal gliomas. This approach can provide a direct pathway to lateral or ventrolateral spinal gliomas with minimal damage to normal spinal cord.
Assuntos
Glioma , Neoplasias da Medula Espinal , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Glioma/cirurgia , Glioma/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento , Cordotomia/métodos , Procedimentos Neurocirúrgicos/métodos , Imageamento por Ressonância Magnética , IdosoRESUMO
BACKGROUND AND OBJECTIVES: Cordotomy, the selective disconnection of the nociceptive fibers in the spinothalamic tract, is used to provide pain palliation to oncological patients suffering from intractable cancer-related pain. Cordotomies are commonly performed using a cervical (C1-2) percutaneous approach under imaging guidance and require patients' cooperation to functionally localize the spinothalamic tract. This can be challenging in patients suffering from extreme pain. It has recently been demonstrated that intraoperative neurophysiology monitoring by electromyography may aid in safe lesion positioning. The aim of this study was to evaluate the role of compound muscle action potential (CMAP) in deeply sedated patients undergoing percutaneous cervical cordotomy (PCC). METHODS: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy while deeply sedated between January 2019 and November 2022 in 2 academic centers. The operative report, neuromonitoring logs, and clinical medical records were evaluated. RESULTS: Eleven patients underwent PCC under deep sedation. In all patients, the final motor assessment prior to ablation was done using the electrophysiological criterion alone. The median threshold for evoking CMAP activity at the lesion site was 0.9 V ranging between 0.5 and 1.5 V (average 1 V ± 0.34 V SD). An immediate, substantial decrease in pain was observed in 9 patients. The median pain scores (Numeric Rating Scale) decreased from 10 preoperatively (range 8-10) to a median 0 (range 0-10) immediately after surgery. None of our patients developed motor deficits. CONCLUSION: CMAP-guided PCC may be feasible in deeply sedated patients without added risk to postoperative motor function. This technique should be considered in a group of patients who are not able to undergo awake PCC.
Assuntos
Cordotomia , Dor Intratável , Humanos , Cordotomia/métodos , Eletromiografia , Estudos Retrospectivos , Tratos Espinotalâmicos/cirurgiaRESUMO
BACKGROUND: Severe and treatment-resistant pain is a major issue for patients with cancer. Cordotomy is an effective approach for addressing severe cancer-related pain. It is based on blocking the transmission of pain by damaging the lateral spinothalamic tract. METHODS: Computed tomography guided cordotomy was performed on 14 patients who did not respond to medical and interventional pain management methods. RESULTS: Fourteen patients with cancer pain underwent CT-guided percutaneous cordotomy. Pain relief was reported in 86% of the patients. The visual analog scale values before and after cordotomy were compared and a significant difference was found (p = 0.0001). The improvement in the Karnofsky Performance Scale score of the patients was found to be statistically significant (p = 0.0001). CONCLUSION: We believe that CT-guided cordotomy, performed by experienced hands in a team of experienced individuals and applied to the right patients, is an effective treatment. However, it is crucial to exercise extreme caution regarding potential side effects and serious complications during the cordotomy procedure.
Assuntos
Dor do Câncer , Neoplasias , Dor Intratável , Humanos , Cordotomia/efeitos adversos , Cordotomia/métodos , Dor do Câncer/cirurgia , Dor do Câncer/etiologia , Neoplasias/complicações , Dor Intratável/etiologia , Dor Intratável/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: To assess the outcomes of endoscopic assisted microscopic posterior cordotomy for bilateral abductor vocal fold paralysis (BAVFP) using radiofrequency versus coblation. METHODS: This was a randomized prospective cohort study that carried out on 40 patients with BAVFP who were subjected to endoscopic/assisted microscopic posterior cordotomy. The patients were randomly allocated into two groups: group (A) patients were operated with radiofrequency, and group (B) patients were operated with coblation. Glottic chink, grade of dyspnea, voice handicap index 10 (VHI10), and aspiration were evaluated pre-operatively and 2 weeks and 3 months post-operatively. RESULTS: There was a significant improvement in the glottic chink and VHI10 scores postoperatively with a non-significant difference between both groups regarding the degree of improvement. In addition, there was a significant improvement of the grade of dyspnea with a non-significant impact on the degree of aspiration in both groups post operatively. There was a lower incidence of oedema and granulation formation in the coblation group but without a statistical significance. CONCLUSION: Both techniques are effective alternatives for performing posterior transverse cordotomy in cases of BAVFP.
Assuntos
Paralisia das Pregas Vocais , Prega Vocal , Humanos , Prega Vocal/cirurgia , Cordotomia/efeitos adversos , Cordotomia/métodos , Estudos Prospectivos , Laringoscopia/métodos , Resultado do Tratamento , Qualidade da Voz , Paralisia das Pregas Vocais/cirurgia , Paralisia das Pregas Vocais/complicações , Dispneia/etiologia , Dispneia/cirurgia , Aspiração Respiratória/complicaçõesRESUMO
OBJECTIVE: Cordotomy is a viable option for patients with intractable cancer pain and limited survival. Open thoracic cordotomy is offered when patients are not candidates for percutaneous cordotomy. After the open procedure, traditionally performed purely based on anatomic landmarks, up to 22% of patients experience postoperative limb weakness. The objective of this study is to report our experience with neurophysiology-guided open cordotomy along with a critical review of the literature. METHODS: Between 2019 and 2022, 5 open thoracic cordotomies were performed in our center. Intraoperative neurophysiologic monitoring was used in all cases to guide the lesion and standard single-level laminectomy or hemilaminectomy was performed for exposure. Outcome measures were retrospectively reviewed focusing on pain control and neurologic status. Existing literature on cordotomy was critically reviewed. RESULTS: There was satisfactory pain relief with preservation of motor function in all 5 cases. Temperature sensation was preserved in all but 1 patient, who lost it after the previous ipsilateral percutaneous cordotomy (PCC). No procedural complications were experienced. We found that the neurophysiology monitoring lesion was guided anterior compared with what would have been lesioned on an anatomic basis. CONCLUSIONS: Open thoracic cordotomy is a safe and effective procedure for intractable cancer-related pain. Technical advancements significantly reduced mortality and major morbidity of PCC. Our series suggests that neurophysiology monitoring alters the location of the lesion and may help better targeting of pain fibers within the spinothalamic tract and preserve other long tracts. The safety profile of open cordotomy with neurophysiology compares favorably with the PCC.
Assuntos
Dor do Câncer , Neoplasias , Dor Intratável , Humanos , Cordotomia/efeitos adversos , Dor do Câncer/cirurgia , Estudos Retrospectivos , Procedimentos Neurocirúrgicos/efeitos adversos , Tratos Espinotalâmicos/cirurgia , Neoplasias/cirurgia , Dor Intratável/cirurgiaRESUMO
BACKGROUND: Some cancers of the lower extremity involve nerves and plexuses and can produce extreme drug-resistant noceptive pain. In these cases, open thoracic cordotomy can be proposed. METHOD: This procedure involves disruption of the spinothalamic tract, which sustains nociceptive pathways. After placement in the prone position, selection of the side to be operated on (contralateral to the pain), and dura exposure, microsurgery is used to section the anterolateral spinal cord quadrant previously exposed by gently pulling on the dentate ligament. CONCLUSION: Open thoracic cordotomy is a moderate invasive, safe, and effective option for the management of drug-resistant unilateral lower extremity cancer pain in well-selected patients.
Assuntos
Dor do Câncer , Neoplasias , Dor Intratável , Humanos , Cordotomia/métodos , Dor do Câncer/cirurgia , Medula Espinal/cirurgia , Dor Intratável/cirurgiaRESUMO
OBJECTIVES: To investigate the effect of transoral CO2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy for bilateral vocal fold paralysis (BVFP). DESIGN: A retrospective study with medical records from 2017 to 2021 in our hospital. SETTING: A single-centre study. PARTICIPANTS: This retrospective study included 22 patients with BVFP. They underwent transoral CO2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy in our hospital from 2017 to 2021. MAIN OUTCOME MEASURES: Preoperative and postoperative swallowing and phonation functions were evaluated in all patients. RESULTS: All 22 patients with a tracheostomy were successfully decannulated within 6 months after surgery without subsequent revision operations, and the width of the posterior glottis was more than 3.9 mm in all patients when they inspired. The statistical analysis showed that there was no difference in vocal function and swallowing function in all patients compared to preoperative (p > .05). CONCLUSION: Transoral CO2 laser-modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy enlarges the posterior glottis in patients with BVFP, which maintains airway patency without significant worsening in voice and swallowing function.
Assuntos
Terapia a Laser , Lasers de Gás , Paralisia das Pregas Vocais , Humanos , Prega Vocal/cirurgia , Estudos Retrospectivos , Dióxido de Carbono , Cordotomia , Resultado do Tratamento , Paralisia das Pregas Vocais/cirurgiaRESUMO
INTRODUCTION: Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy. METHODS: The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded. RESULTS: We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated. CONCLUSION: Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring. Laryngoscope, 133:6-14, 2023.
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Laringoplastia , Paralisia das Pregas Vocais , Humanos , Cordotomia , Glote , Estudos Retrospectivos , Paralisia das Pregas Vocais/cirurgia , Paralisia das Pregas Vocais/complicaçõesRESUMO
A 75-year-old man presented to our Interventional Cancer Pain service for consideration of a percutaneous cervical cordotomy (PCC) to control severe chest wall pain secondary to malignant mesothelioma. His medical history included a neuroinflammatory disorder, neuromyelitis optica, for which he had previously had a prolonged hospital admission, with ongoing neurological deficit. Little information is available regarding the safety of PCC in a patient with this condition, specifically the risk of neurological relapse, and we were initially wary about going ahead. After discussion with the patient's neurology team and other UK experts and with the patient's informed consent, we proceeded to PCC with additional steroid cover. No adverse neurological symptoms were encountered perioperatively or postoperatively and the patient had an excellent analgesic result. As this combination of circumstances has not to our knowledge been documented, we wished to present this case and discuss the factors affecting our decision and management.
Assuntos
Mesotelioma Maligno , Mesotelioma , Parede Torácica , Masculino , Humanos , Idoso , Cordotomia , Mesotelioma Maligno/complicações , Mesotelioma Maligno/cirurgia , Parede Torácica/cirurgia , Recidiva Local de Neoplasia , Mesotelioma/complicações , Mesotelioma/cirurgia , Dor/complicaçõesRESUMO
BACKGROUND: Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood. OBJECTIVE: To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes. METHODS: Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale). RESULTS: All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037). CONCLUSION: The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.
Assuntos
Dor do Câncer , Neoplasias , Dor Intratável , Dor do Câncer/cirurgia , Cordotomia/efeitos adversos , Cordotomia/métodos , Humanos , Neoplasias/cirurgia , Limiar da Dor , Dor Intratável/cirurgiaRESUMO
BACKGROUND/AIM: Sacral chordoma is a rare primary bone neoplasm associated with high morbidity. The aim of this study is to identify demographic and clinicopathological characteristics of this tumor and evaluate their impact on survival outcomes. PATIENTS AND METHODS: The Surveillance, Epidemiology and End Results (SEER) database collecting data between 2000 and 2018 was searched for all cases of sacral chordoma. We analyzed demographic aspects, cancer stage and treatment patterns. Overall survival was calculated using the Kaplan-Meier method and compared between subgroups using the log-rank test. A multivariate Cox hazard regression analysis was conducted to identify independent predictors of overall survival. RESULTS: Four hundred and forty-two patients were identified with a mean age of 62.7 years. Most tumors presented regional invasion at diagnosis (43.2%). Mean overall survival was 124.7 months. No significant difference in terms of overall survival was found between surgery alone and surgery associated with radiotherapy. Both options provided a significantly increased survival than radiotherapy alone. Age of less than 50 years or between 50 and 69 correlated significantly with improved survival. CONCLUSION: Age and stage at diagnosis impact significantly survival outcomes. Surgery remains the mainstay treatment with the highest overall survival. Its association with radiotherapy is currently questionable and needs further research.
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Cordoma/epidemiologia , Neoplasias da Coluna Vertebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cordoma/mortalidade , Cordoma/patologia , Cordoma/terapia , Cordotomia/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radioterapia Adjuvante/mortalidade , Programa de SEER , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/terapia , Análise de Sobrevida , Suíça/epidemiologia , Adulto JovemRESUMO
BACKGROUND: A prospective randomized study was conducted on 40 patients with true bilateral vocal fold abductor paralysis. The patients under the study were divided into 2 groups, group (A) including 20 patients who underwent laser posterior cordotomy and another group (B) including 20 patients who underwent combined laser posterior cordotomy with suture lateralization, the patients under the study presented at otorhinolaryngology outpatient clinic at faculty of medicine, Cairo University. The study was conducted in the period from January 2018 till January 2021. RESULTS: No significant difference between both surgeries regarding respiratory efficiency, voice handicap index (VHI) scores, and presence of postoperative aspiration. A significant difference was found regarding some Computerized Speech Lab (CSL) measures (there is a statistically significant difference between the 2 groups in favor of group (b) regarding N to H ratio in week 2 postoperatively and maximum phonation time in 4-week postoperatively) and granuloma formation (granuloma formation was more common in the group (A) than group (B)). CONCLUSION: Combined laser posterior cordotomy with suture lateralization in bilateral vocal folds abductor paralysis showed fewer complications and better maximum phonation time and a comparable effect to laser cordotomy regarding respiration.
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Terapia a Laser , Paralisia das Pregas Vocais , Cordotomia , Humanos , Lasers , Estudos Prospectivos , Suturas , Resultado do Tratamento , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgiaRESUMO
A young woman was admitted to our palliative care unit with severe pain to her right hip and leg. Her pain was uncontrolled despite aggressive use of opioids, adjuvant pain medications and spinal analgesia. She experienced significant psychological and social distress, but engaging in therapies with our multidisciplinary team proved difficult. Surgical cordotomy was pursued, which improved the physical pain and allowed her to re-engage in social and familial roles and meaningful activities. This case gives context to discuss the complex interactions between physical pain and psychosocial suffering. It is challenging to determine the relative contributions of physical, psychological, existential and social suffering, and this case highlights the complex relationships between these domains. In this case, managing the physical pain by means of a surgical cordotomy allowed the patient the opportunity to address other domains of suffering.
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Cordotomia , Cuidados Paliativos , Ansiedade , Feminino , Humanos , Dor/psicologia , Manejo da Dor , Cuidados Paliativos/psicologiaRESUMO
BACKGROUND: Percutaneous cervical cordotomy (PCC) offers pain relief to patients with unilateral treatment-refractory cancer-related pain. There is insufficient evidence about any effects of this intervention on patients' quality of life. METHOD: Comprehensive multimodal assessment to determine how PCC affects pain, analgesic intake and quality of life of patients with medically refractory, unilateral cancer-related pain.This study was set in a multidisciplinary, tertiary cancer pain service. Patient outcomes immediately following PCC were prospectively recorded. Patients were also followed up at 4 weeks. RESULTS: Outcome variables collected included: background and breakthrough pain numerical rating scores before PCC, at discharge and 4 weeks postprocedure; oral morphine equivalent opioid dose changes, Patient's Global Impression of Change, Eastern Cooperative oncology group performance status and health related quality of life score, that is, EuroQol-5 dimension-5 level (EQ-5D). CONCLUSIONS: Despite significant improvement in pain and other standard outcomes sustained at 4 weeks, there was little evidence of improvement in EQ-5D scores. In patients with terminal cancer, improved pain levels following cordotomy for cancer-related pain does not appear to translate into improvements in overall quality of life as assessed with the generic EQ-5D measure.
Assuntos
Dor do Câncer , Neoplasias , Dor do Câncer/etiologia , Dor do Câncer/cirurgia , Vértebras Cervicais/cirurgia , Cordotomia/métodos , Humanos , Neoplasias/complicações , Neoplasias/cirurgia , Estudos Prospectivos , Qualidade de VidaRESUMO
OBJECTIVES: Bilateral adductor vocal cord paralysis (BAVCP) is a rare and challenging condition whose main consequence is reduction of airway patency at the glottic level, often causing respiratory distress, while vocal function tends to remain almost normal. We investigated the effect of transoral glottal widening on quality of life and decannulation rates in patients affected by BAVCP. METHODS: We retrospectively evaluated patients affected by BAVCP and treated by transoral CO2 posterior cordotomy with or without medial partial arytenoidectomy (PC ± MPA) at two referral centers. The primary outcome was change in quality of life, evaluated pre- and post-operatively by the ADVS, VHI-30, and EAT-10 questionnaires. Secondary outcomes were the need for retreatments and, for patients with tracheotomy, the time to decannulation. RESULTS: Thirty-three patients met selection criteria. The etiology was post-surgical in 27 cases (81.8%), idiopathic in 4 (12.1%), a trauma-related in 1 (6.0%), and to other causes in 1 (3.0%). In 22 cases (66.7%), PC was combined with MPA. A significant improvement in responses for the ADVS (p < .0001) and EAT-10 (p < .0001) was observed, whereas the VHI-30 score did not change significantly post-operatively. All nine patients with a tracheostomy were successfully decannulated within 18 months after the surgical procedure. CONCLUSIONS: For patients affected by BAVCP, PC ± MPA by transoral CO2 laser microsurgery is a safe, customizable and minimally invasive treatment that can guarantee an affordable balance between quality of life in terms of phonation and swallowing and acceptable airway patency.
Assuntos
Terapia a Laser , Lasers de Gás , Paralisia das Pregas Vocais , Cartilagem Aritenoide/cirurgia , Dióxido de Carbono , Cordotomia , Humanos , Laringoscopia , Lasers de Gás/uso terapêutico , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Paralisia das Pregas Vocais/cirurgia , Prega VocalRESUMO
OBJECTIVE: To review our experience with punctate midline myelotomy (PMM) for malignant and benign visceral pain with an emphasis on detailed side-effect profiles and efficacy. METHODS: Thirteen adults (5 men) underwent microsurgical transverse-crush PMM. RESULTS: Median follow-up for the benign pain group (n = 6) was 17.5 months (10-72) and for the malignant group (n = 7) was 8 months (0.5-31). Five of seven patients in the malignant pain group obtained excellent, lasting relief. Two had initial relief followed by worsening pain with disease progression. In the benign pain group, two patients with endodermal-origin pain (gastrointestinal tract, bladder) had complete, long-lasting relief. Three patients with mesodermal-origin pain (ureter) had excellent relief for 2-3 months, followed by recurrence in two and partial (40%) recurrence in the third. One man with pre-existing cervical myelopathy underwent PMM for benign testicular-region pain from which he had long-term relief but only transient relief of coexisting low-back and leg pain. There were no motor deficits in either group, and all patients remained ambulatory and continent. The most common side effect was transient numbness of the medial leg and foot. Two patients (both with pre-existing spinal pathology) reported persistent moderate reduction of bowel, bladder, and sexual sensation. CONCLUSIONS: PMM offers substantial pain relief for carefully selected patients with intractable visceral pain. Relief from primarily endoderm-derived structures was most complete and long-lasting. Relief from mesoderm-derived structures was typically transient or incomplete. There was essentially no relief from pain of ectoderm-derived structures. Detailed preoperative counseling is important, especially for those with pre-existing neurologic deficits.
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Cordotomia/métodos , Procedimentos Neurocirúrgicos/métodos , Dor Intratável/cirurgia , Dor Visceral/cirurgia , Adulto , Idoso , Dor do Câncer/cirurgia , Cordotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Hipestesia/etiologia , Imageamento por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Medição da Dor , Dor Pélvica , Recidiva , Resultado do TratamentoRESUMO
Cordotomy consists in the discontinuation of the lateral spinothalamic tract (LST) in the anterolateral quadrant of the spinal cord, which aims to reduce the transference of nociceptive information in the dorsal horn of the gray matter of the spinal cord to the somatosensory cortex. The main indication is for patients with terminal cancer that have a low life expectancy. It improves the quality of life by relieving pain. The results are promising and the pain relief rate varies between 69 and 100%. Generally speaking, the complications are mostly temporary and not remarkable.