Cervical Cordotomy in Terminal Cancer: Pain Relieving in Oncological Treatment

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.

Cervical cordotomy for the treatment of oncological pain / Cordotomia cervical para tratamento da dor oncológica: revisâo de literatura

Cordotomy consists in the discontinuation of the spinothalamic tract in the anterolateral quadrant of the spinal cord and aims to reduce the transference of nociceptive information in the dorsal horn of the grey matter of the spinal cord (CPME) for rostral units at the neural axis. Many modalities of cordotomy may be employed: anterior transdiscal between C4-C5; endoscopic infra mastoid tip between C1-C2; percutaneous guided by fluoroscopy infra mastoid tip between C1-C2; percutaneous guided by CT infra mastoid tip between C1-C2; open cordotomy by means of laminectomy. The main indication is for patients in advanced cancer disease with severe neuropathic pain bellow the neck in whom the period of survival due to cancer disease is inferior to 3-4 months. The results for immediate pain relieve ranges from 69% to 100% of the cases, while preoperative Karnofsky scores were 20 and 70, respectively versus post operative Karnofsky scores of 20 and 100 respectively; the difference was determined to be highly significant (p < 0.001).

A cordotomia consiste na discontinuação do trato espinotâmico no quadrante ântero-lateral da medula espinal e visa reduzir a transferência de informação nociceptiva no corno dorsal da substância cinzenta da medula espinal (CPME) para as unidades rostrais no neuroeixo. Muitas modalidades de cordotomia podem ser empregadas: transdiscal anterior entre C4-C5; endoscópica inframastoidea entre C1-C2; Percutânea inframastoidea entre C1-C2 guiada por fluoroscopia; percutânea inframastoidea entre C1-C2 guiada por TC; cordotomia aberta por laminectomia. A principal indicação é para pacientes com câncer avançado com dor neuropática severa abaixo do pescoço nos quais a sobrevida devido ao câncer é inferior a 3-4 meses. Os resultados para alívio imediato da dor varia de 69% a 100% dos casos, enquanto os escores de Karnofsky foram de 20 e 70 no período pré-operatório, para 20 e 100 no período pós-opertaório; a diferença foi estatisticamente significativa (p < 0.001).

El Instituto de Neurocirugía e Investigaciones Cerebrales de Santiago de Chile y la primera neurocirujana en Latinoamérica / The Institute of Neurosurgery and Cerebral Research in Santiago de Chile and the first neurosurgeon woman in Latinamerica

La mexicana María Cristina García-Sancho de Penichet (1919- ) fue la primera neurocirujana en América Latina. Estudió medicina en una época en que la inserción de la mujer en esta disciplina todavía era baja y se decidió por una especialidad, inclusive difícil para los mismos hombres; la neurocirugía. Se preparó en este campo con uno de los grandes neurocirujanos de la época, Alfonso Asenjo Gómez (1906-1980) y en uno de los mejores lugares del mundo, el Instituto de Neurocirugía e Investigaciones Cerebrales en Santiago de Chile. Su aportación a la neurocirugía fue haber modificado el proceso quirúrgico de la cordotomía, operación para controlar el dolor y que tradicionalmente se hacía en dos tiempos. La doctora García-Sancho propuso realizarla en un solo paso.

María Cristina García-Sancho de Penichet (1919- ), a Mexican, was the first woman neurosurgeon in Latin America. She studied medicine at a time when women’s participation in medicine was limited, yet she chose specialization that was considered difficult even for men: neurosurgery. She trained in this discipline with one of the great neurosurgeons of the time, the Chilean Alfonso Asenjo Gómez (1906-1918), and at one of the most prestigious establishments in the world: the Institute of Neurosurgery and Cerebral Research in Santiago de Chile. Her main contribution to the field of neurology consisted in modifying the surgical procedure called cordotomy, an operation for pain control that traditionally required a two-step procedure, but which Dr. García-Sancho showed could be performed in just one step.

Transient Repiratory Dysfunction after Percutaneous Cordotomy: A case report / 대한통증학회지

Percutaneous cordotomy is a useful method for cancer pain management. Candidates for cervical cordotomy include those patients with unilateral cancer pain below the shoulder, with a life expectancy of less than 1 year, who can not be adequately treated by other less invasive methods. However, various complications can occur following a cordotomy, with the most serious being respiratory dysfunction. Herein, we report a case of transient respiratory dysfunction following a percutaneous cervical cordotomy.

Analysis on the Treatment Outcome of Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The choice of the treatment in early glottic cancer depends on various factors. To evaluate the differences between the radiotherapy and conservation, laryngeal surgery including laser cordectomy, vertical hemilaryngectomy and supracricoid partial laryngectomy in early glottic cancer is thought to be valuable in defining the exact indication and recommending treatment modality on the early glottic cancer patients. MATERIALS AND METHOD: The medical records of 136 patients with glottic TisN0, T1N0 or T2N0 cancer diagnosed at Asan medical center, University of Ulsan college of medicine from May, 1989 to July, 2001 were retrospectively reviewed. The five-year survival rate, local control rate, and expenses were compared among the radiation therapy group, the laser cordectomy group and the partial laryngectomy group. RESULTS: Surgical management and radiotherapy showed 97.2% and 96.0% 5-year survival rate, respectively. And laser cordectomy and partial laryngectomy had 95.0% and 92.9% local control rate, respectively while radiotherapy got 87.6% local control rate. Laser cordectomy costs lower than any other treatment. CONCLUSION: On the basis of the oncologic result, both the surgery and radiotherapy had the similar results, but surgical management seemed to show more organ preservation rate. Besides, in anterior commissure invasion, there was no significant difference between the survival and local control rate between surgery and radiotherapy.

Percutaneous Cordotomy Using Thermocouple Electrodes / 대한마취과학회지

Effective noninvasive modalities such as radiotherapy and pharmacologic treatments have become highly developed in the treatment of intractable cancer pain. Although epidural narcotics have been considered particularly useful, limitations still remain in their effectiveness for some patients. Surgical therapy can be a useful alternative to these treatments. Cordotomy is one of the most effective surgical treatments. The first percutaneous cordotomy was attempted by Mullan and his associates in 1963. Rosomoff and his associates modified the procedure using radiofrequency two years later. Cordotomy was widely used by the late 1960's but due to its limited effectiveness and serious complications it was abandoned until 1980 when a new electrode was developed by Levin. A thermocouple cordotomy electrode such as the Levin electrode allows monitoring of impedance and tissue temperature. A radiofrequency lesion can be made by increasing the current directly to the desired temperature rather than by gradual heating with the usual incremental increases in lesion current and time. With the use of this electrode, consistent clinical effects are assured and operating time is reduced. The chances of boiling or charring are also minimized. Since this electrode was developed, cordotomy has received renewed attention virtually everywhere except in Korea. Five terminal cancer patients in whom conservative treatments had failed were treated by cordotomy using the three types of thermocouple electrodes: the levin cordotomy electrode; the TCE thermocouple electrode, and the Kanpolat CT electrode. Due to the small number of patients, a comparison of the effectiveness of these three types could not be made. Although complete pain relief was not achieved in every case, dosages of narcotics could be reduced as a result of this procedure. There were no serious complications except a transient paralysis of the ipsilateral arm in one case and headaches in four cases.

Clinical Analysis on Open Thoracic Cordotomy of the Cancer Pain

Patients with pain syndromes resulting from recurrent or metastatic cancer should be evaluated carefully to determine the cause of their pain and the need for appropriate antitumor treatment. The most effective ablative pain control procedure at the current time is cordotomy, which is indicated in patients with unilateral pain. The authors results of 12 antero-lateral thoracic cordotomies performed for intractable cancer pain between 1996-1998. The follow-up of these patients was continued for at least 12 months or until death to determine the late success of this procedure. Excellent surgical results were obtained in 100% after one week and in 50% in 6 months after operation. The operation was considered to be successful for patients with malignant disease of short life expectancy.