Percutaneous Cervical Radiofrequency Cordotomy for Intractable Pain

The technique of anterolateral cordotomy for relief of pain was first performed by Spiller and Martin (1912). It was accepted as the best available method for long-term relief despite its disadvantages. It has been well documented that the procedure often caused weakness of an extremity or the loss of sphincter control and respietory impairment associated with high surgical cervical cordotomy. In 1963, Mullan et al. devised an approach to the cervical spinal cord by inserting a needle through the neck under roentgenologic control. They introduced a radioactive needle (Strontium90) to produce a lesion interrupting the lateral spinothalamic tract. Mullan and Rosomoff et al. (1965) later simplified the produce by using an electrical current to produce the lesion. The percutaneous method has considerable advantages. The mortality and morbidity are very small and the technique can be used on any patient including even the terminal state. If the required level is not attained on the first attempt, or if the level subsequently drops, the procedure is easily repeated. Most patients can be discharged early after this type of cordotomy. Authors have reviewed 46 cordotomies on 35 patients with intractable pain carried out by the percutaneous radiofrequency procedure at the Neurosurgery Department of Yonsei University from 1972 to 1975:36 cases were treated by a modification of the Rosomoffs technique, 10 cases by Lin's technique. Intractable pain has been a continuing problem in neurosurgery and many methods have been employed in its treatment. The function of lateral spinothalamic tract was described by Spiller and Martin in 1912. and they described the posterior approach to the spinal cord which has been widely used for cordotomy in the 50 years since. However, in elderly or debilitated patients, this method has proved to have many complications and is poorly tolerated and has a morbidity and mortality rate. In 1963, Sean Mullan, using a Strontium90 electrode accomplished a lateral spinothalamic cordotomy by stereotaxic surgery under local anesthesia (Mullan, et al., 1963; 1965; 1965). Later, in 1965, Rosomoff (Rosomoff,et al., 1965; Rosomoff, et al., 1966) developed an improved technique using UHF radio waves, which achieved wide popularity. Using radiological equipment and measuring the impedance of various portions of the spinal cord with electrodes, the exact area of the lateral spinothalamic tract to be destroyed could be located. Utilizing localizing electrodes and the above method, complications from destruction of the tracts near the lateral spinothalamic tract which formerly resulted in hemiparesis, respiratory difficulty, urinary difficulties and other surgical difficulties could be minimized much more effectively than with open surgical approaches (Mullan and Hosobuchi, 1968). In bilateral, high cervical cordotomy the complication of sleep induced apnea may be a cause of death. Belmusto (Belmusto, et al., 1963; Belmusto; et al., 1965) indicated that the respiratory fibers are very near the lateral spinothalamic tract in the C-1 to C-3 spinal region. The respiratory fibers are located in the anterior one fourth of the spinal cord, extending from the median fissure 3~3.5 mm lateral wards towards the region of the median part of the lateral spinothalamic tract. (Mullan and Mosobuchi, 1968; Nathan, 1963; Hitchcock and Lee ce, 1967; Crosby, et al., 1962). In 1966, Lin (Lin, et al., 1966), developed a low cervical anterior approach, in order to avoid damage to the respiratory tract, and found that respiratory tract damage was actually decreased, and also found that regional analgesia was easily accomplished. Over the last three years, the authors, applying a percutaneous cervical cordotomy technique, have studied 46 patients, recording the present illness, method of surgery, postoperative analgesic area and its change with time, and complications. This material was analyzed and conclusions drawn.

Malignant Melanoma in the Spinal Cord: Report of a Case

Malignant melanoma of the spinal cord is a rare tumor 3,8,9,12 The melanomas that originate in the meninges bear a general structural resemblance to those arising elsewhere, but it is questionable whether they ever metastasis outside the central nervous system7. If can be also argued that the primary central nervous system melanoma could actually be a metastasis from an occult primary site in the skin, esophagus, rectum or other sites6. We are reporting a case of malignant melanoma involving the cervical spinal meninges and hard palate.