Mielotomia punctiforme no tratamento da dor oncológica visceral: análise de três casos / Punctate midline myelotomy for the treatment of oncologic visceral pain: analysis of three cases

INTRODUÇÃO: Uma nova via relacionada com a dor visceral foi recentemente descrita. Esta via localiza-se na linha média da coluna dorsal na medula espinhal, sendo o alvo da técnica cirúrgica aqui descrita. OBJETIVO: Apresentar os resultados de três pacientes submetidos ao tratamento da dor visceral oncológica por mielotomia punctiforme. MÉTODO: Três pacientes, com dor abdominal oncológica refratária ao tratamento clínico, foram submetidos à mielotomia punctiforme por meio de de pequena laminectomia torácica. RESULTADOS: Dois pacientes obtiveram controle completo da dor, sendo que um deles não mais necessitou de opióides. O terceiro paciente, que era intolerante aos opióides, obteve melhora de 80 por cento da dor. Nenhum dos pacientes apresentou déficit neurológico no pós-operatório. CONCLUSÃO: Ratificamos a existência de uma via, localizada na linha média da coluna dorsal, relacionada com a dor visceral em humanos, cuja ablação está relacionada à melhora da dor abdominal visceral de origem oncológica.

Tractotomía espino-talámica percutánea por vía lateral: resultado en 218 pacientes / Percutaneous spinothalamic tractotomy by lateral way: results in 218 patients

Se presentan los elementos de la técnica de la tractotomía percutánea espinotalámica por vía lateral para el tratamiento del dolor intratable y los resultados obtenidos en 218 pacientes consecutivos operados por los autores en el Instituto de Neurocirugía Asenjo. Se resalta el renacer del interés en este tipo de cirugía debido a la obtención de resultados inferiores a los esperados por los procedimientos no quirúrgicos. La simplicidad del método permite la realización del procedimiento incluso en enfermos añosos y terminales

Tractotomía espino-talámica percutánea: un método eficaz en el manejo del dolor intratable / Percutaneous spinothalamic tractotomy: an efficient method in the handling of intractable pain

Los principales elementos de la técnica de la tractotomía percutánea espinotalámica por vía lateral y los resultados obtenidos en 205 pacientes consecutivos son comunicados. Hacemos énfasis en la importancia de su uso precoz en caso de dolor intratable, evitando así la drogadicción. La simplicidad del método permite una selección no muy estricta de los pacientes, en comparación con la clásica cordotomía a cielo abierto

Operaçäo de Cotté-Castaño: indicaçöes e resultados / Cotté-Castaño surgery: indications and results

Os autores estudaram 23 casos de pacientes submetidos à operaçäo de Cotté ou Cotté-Castaño. Analisaram as indicaçöes, a técnica e os resultados obtidos. Avaliaram as complicaçöes. Concluíram que tal técnica cirúrgica, da neurectomia pré-sacra e ovárica, näo deve ser totalmente abandonada, havendo ainda lugar para sua indicaçäo, no arsenal terapêutico das algias pélvicas, em circunstâncias que seräo comentadas

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.