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.

Mesencephalotomy, How I Do It: Analysis of 34 Cases

The present paper aims to demystify the use of rostral mesencephalic reticulotomy (mesencephalotomy) in the treatment of chronic pain in cancer patients. A retrospective review of the medical records from the Central Pain and Stereotaxy Department of the A. C. Camargo Cancer Center, São Paulo, state of São Paulo, Brazil, between 2005 and 2012, was performed. Surgical indication was restricted to patients with cancer pain refractory to etiological and symptomatic treatments, > 2 months of expected survival, preserved cognition, and absence of coagulation disorders, of systemic infection, and of intracranial hypertension. We have selected 34 patients, with an average follow-up of 9.4 months, an average age of 54.3 years-old, and an average follow-up time until death of 6.4 months. Lung cancer was themost frequent diagnosis. Satisfactory and immediate pain relief was achieved in 91% of the cases, and 83% of these patients had no relapses. Among the complications, ocular movement disorder was the most frequent, but often transient. Permanent disturbances occurred in 8.8% of the cases (diplopia, rubral tremor, and paresthesia). Compared to the pharmacological treatment, mesencephalotomy was economically feasible, more effective, and improved quality of life. According to the data presented, it can be concluded that mesencephalotomy is a viable procedure for cancer pain control in selected cases.

Central Pain Due to Traumatic Axonal Injury of the Spinothalamic Tract in Patients with Mild Traumatic Brain Injury

Central pain, a neuropathic pain caused by an injury or dysfunction of the central nervous system, is a common, annoying sequela of mild traumatic brain injury (mTBI). Clarification of the pathogenetic mechanism of central pain is mandatory for precise diagnosis, proper management, and prognosis prediction. The introduction of diffusion tensor imaging allowed assessment of the association of the central pain and injury of the spinothalamic tract (STT), and traumatic axonal injury (TAI) in mTBI. In this review, 6 diffusion tensor tractography studies on central pain due to TAI of the STT in patients with mTBI are reviewed. The diagnostic approach for TAI of the STT in individual patients with mTBI is discussed, centering around the methods that these studies employed to demonstrate TAI of the STT.

Complex Regional Pain Syndrome of Non-hemiplegic Upper Limb in a Stroke Patient: A Case Report

Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.

Central Pain Due to Spinothalamic Tract Injury by Head Trauma Caused by Falling Object

No abstract available.

Central Pain Due to Spinothalamic Tract Injury by Head Trauma Caused by Falling Object

No abstract available.

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).

Long-Term Potentiation of Excitatory Synaptic Strength in Spinothalamic Tract Neurons of the Rat Spinal Cord

Spinal dorsal horn nociceptive neurons have been shown to undergo long-term synaptic plasticity, including long-term potentiation (LTP) and long-term depression (LTD). Here, we focused on the spinothalamic tract (STT) neurons that are the main nociceptive neurons projecting from the spinal cord to the thalamus. Optical technique using fluorescent dye has made it possible to identify the STT neurons in the spinal cord. Evoked fast mono-synaptic, excitatory postsynaptic currents (eEPSCs) were measured in the STT neurons. Time-based tetanic stimulation (TBS) was employed to induce long-term potentiation (LTP) in the STT neurons. Coincident stimulation of both pre- and postsynaptic neurons using TBS showed immediate and persistent increase in AMPA receptor-mediated EPSCs. LTP can also be induced by postsynaptic spiking together with pharmacological stimulation using chemical NMDA. TBS-induced LTP observed in STT neurons was blocked by internal BAPTA, or Ni2+, a T-type VOCC blocker. However, LTP was intact in the presence of L-type VOCC blocker. These results suggest that long-term plastic change of STT neurons requires NMDA receptor activation and postsynaptic calcium but is differentially sensitive to T-type VOCCs.

Restricted Spinothalamic Sensory Loss Below Thoracic Dermatomal Level Caused by Pontine Infarction

Cerebral lesions can cause dermatomal sensory deficit. The most commonly reported site is the medulla oblongata due to its well-separated sensory systems. Dermatomal sensory deficit that has developed after pontine infarctions have been reported in several cases, the majority of which involved the medial lemniscus. However, restricted spinothalamic sensory loss has rarely been reported in pontine infarctions. We report herein a patient who presented with dermatomal spinothalamic sensory deficits below the tenth thoracic level after pontine infarction.

Pure Sensory Deficit at the T4 Sensory Level as an Isolated Manifestation of Lateral Medullary Infarction

In rare cases restricted sensory deficits along the somatotopic topography of the spinothalamic tract can develop from a lateral medullary infarction. To our knowledge, isolated dermatomal sensory deficit as a single manifestation of a lateral medullary infarction has not been reported previously. A 58-year-old man presenting with sudden left-sided paresthesia complained of sensory deficit of pain and temperature below the left T4 sensory level without other neurologic deficits. Diffuse- and T2-weighted magnetic resonance imaging (MRI) of the brain showed high signal intensities in the right lower medulla oblongata, whereas thoracic-spine MRI and somatosensory evoked potentials produced normal findings.

A Case of Lateral Medullary Infraction Presenting with Thoracic Sensory Level

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.

Role of dorsal column in pathway of hypotensive effect of the somatic afferent inputs / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the role of the dorsal column (DC) in the inhibitory effect of somatic afferent inputs on the central pressor response.</p><p><b>METHODS</b>The femoral arterial pressure, mean arterial pressure (MAP), electrocardiogram (ECG) and heart rate (HR) of the male SD rats were recorded when the hypothalamic paraventricular nucleus (PVN) was electrically stimulated with or without destruction of DC. The inhibitory effect of the deep peroneal nerve (DPN) on the pressor response induced by stimulation of PVN was observed 20 min or 5 d after ipsilateral DC destruction.</p><p><b>RESULTS</b>Stimulating DPN inhibited the pressor response elicited by electrical stimulation of PVN with an inhibitory rate of 43.29%. Twenty minutes after destroying the right DC, stimulation of the right or left DPN could inhibit the pressor response with an inhibitory rate of 38.64% and 39.97%, respectively (P>0.05); five days later the inhibitory rates remained as 33.87% and 36.86% respectively (P>0.05). The pain responses of both hindlimbs in the rats with the right DC destroyed showed no significant difference compared with the intact rats.</p><p><b>CONCLUSION</b>DC is not involved in the inhibitory effect of DPN on the pressor response induced by PVN stimulation.</p>

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

A Review of 5 Patients with Pure Sensory Stroke Syndrome

Pure sensory stroke (PSS), first described by Fisher in 1965, is a clinical condition characterized by numbness and paresthesia of the face, arm and trunk on one side, in absence of other neurologic deficit. PSS could arise anywhere along the sensory system from the cerebral cortex to the medulla. The authors experienced 5 patients with PSS: one patient had a hemorrhage on the thalamocortical pathway including the internal capsule and the corona radiata. Two another had thalarnic lesions. The fourth had a pontine hemorrhage with perioral onionpeel distributed face sensor- involvement. And the last had a pontine lacune involving crossed trigeminothalamic tract and lateral spinothalamic tract.

Two Cases of Avellis Syndrome

Avellis syndrome is a clinical disorder characterized by ipsilateral paralysis of palate, larynx, and vocal cord paralysis and contralateral hemianesthesia. The syndrome is usually due to lesion of medulla oblongata. Involeved structures are nucleus ambiguus, lateral spinothalamic tract, and descending sympathetic fibers. We present 2 cases of Avellis syndrome with MRI findings, which showed infarction of right-sided upper medulla oblongata.

Cervical Cordotomy via Anterior Approach without Bone Graft

Cervical cordotomy via anterior approach without bone graft which is a modified Cloward's method is an effective and simple means of relieving of intractable pain with minimal destruction of bone lower morbidity and mortality. This method consists of an anterior surgical approach to the ventral surface of the cervical cord through a simple discectomy. A transverse incision in the dura mater gives excellent exposure permitting incision of the spinothalamic tracts under direct vision. For bilateral pain both incision are made at the same level of the cord without causing impairment of motor function of the lower extremities or bowel and bladder. This procedure has also many advantages and disavantages as follows ; 1. Cervical cordotomy by the this procedure has a much lower morbidity and fewer complications than the conventional procedure by laminectomy. 2. A more complete section of the spinothalamic tract is possible under direct vision. 3. A differential section of the tract with sparing of sensation in non-painful areas is possible by this procedure. 4. An incidence of the cord trauma can be minimized because the incision is possible without distorsion and traction of the cord during the operation. 5. This procedure without bone graft is simpler than original Cloward's method. 6. An water-tight closure of the dura is difficult but successful results are obtained by using a gelfoam. 7. This procedure above the level of the C3-4 interspace is difficult but possible. 8. A relief of pain below the level of the T3 dermatome is available and there is no good operative candidate when the brachial plexus is involved.