Percutaneous Cervical Cordotomy

A case has been reported in which stereotaxic percutaneous cordotomy has been performed for the treatment of an intractable pain in the arm. The 60-year-old male was admitted to this hospital because of right arm pain which was persistant, so severe and intractable to various medical treatment for 2 months prior to admission. The pain in association with right Horners' syndrome has been produced by the involvement of carcinoma in the right apex of the lung to the cords of brachial plexus and superior cervical ganglion. Since the patient was so emaciated and distressed with the pain, the percutaneous cordotomy was indicated for him to cure the pain. Under the local anesthesia the patient was maintained in the supine position with his head held lightly on the head holder. And unilateral high cervical cordotomy by the percutaneous stereotaxic method was performed on the left through C-C2 interlaminar space under radiographic and impedance measurements, which relieved the pain completely with no development of significant postoperative complications. It was simple, safe and effective for the patient who has poor general condition because it does not require a general anesthesia or a period of wound healing and the cooperation of the alert patient eliminates the possibility of paralysis and enhances the changes of securing the desired sensory loss.

Experimental Brain Edema(Part III)

The cerebral compression and edema were successfully produced by the expansion of the stalk of laminaria in the right epidural space of the rabbits. By weighting the wet and dry brain tissues, and by calculating the percentage of water content and that of swelling, with the rate of per cent water content to that of control group, the studies of the occurrence and changes of experimental brain edema have been observed. In the normal rabbits, the average per cent water content of cerebral gray and white matters were 79.9+/-0.7% and 73.0+/-1.0% respectively. The percentage of water content and swelling of cerebral gray and white matters in the compression site showed higher values than those in control group. As compared with normal group, the rate of per cent water content of cerebral gray matter at the site of compression showed gradual increasing tendency as time elapsed by 24 hours, while that of white matter demonstrated rapid increased of it by 6 hours and decreased gradually thereafter. And it appeared that the value of the cerebral white matter showed higher than that of gray matter throughout the period of 24 hour's compression. Cereral edema induced by laminaria compression was more evident and severe in the white matter than in the gray, which was more striking at the early stage of cerebral compression.

Experimental Spinal Cord Compression: Part I, Water Content and Oxygen Consumption

Experimental spinal cord compression was successfully produced in the rabbit by the expansion of the stalks of "laminaria", a sea weed, which was placed in the spinal epidural space at the level of fifth lumbar vertebrae. The experimental spinal cord compression and subsequent edema at the site of compression and its adjacent area were studied at interval of 6, 12 and 24 hour's compression by measuring wet weight and dry weight, and by calculating percent water contents, swelling percent and changesa of water content to that in control group. The oxygen consumption of cord tissues at the site of compression and its distal adjacent area of the spinal cord was investigated by using Warburg's manometric apparatus supplying 100% oxygen. In the normal rabbit, the average water content of the spinal cord was 63.38+/-0.9%. The percentage of water and swelling of the cord tissues in experimental group were higher than those in the control during the period of 24 hour's compression, and that at the site of compression they showed a tendency of rapid increase in value at an early stage, and the area adjacent to the compression demonstrated values increasing gradually during the process of compression. In control group, the average value of oxygen consumption of the cord tissue was 0.48+/-0.01---lO2 mg(dry weight)/30 min. The values of oxygen consumption of cord tissue at the site of compression and distal adjacent area were higher than in control group at an early stage and gradually decreased thereafter. It was noted that the changes of water content and oxygen consumption of spinal cord were well and influenced by the mechanical compression with "laminaria" insertion in the rabbit, resulting in spinal cord edema.

Percutaneous Streotaxic Gasserian Ganglionotomy with Radiofrequency Current in Trigeminal Neuralgia

Chemical destruction of Gasserian ganglion by either alcohol or phenol has remained a popular form of treatment for tic pain. However, control of the lesion size is inaccurate and various complications have often resulted. With advent of radiofrequency generator, percutaneous coagulation of the Gasserian ganglion is now possible, and the need for open surgery or chemical destruction have been drastically reduced. We treated 3 cases of trigeminal neuralgia with the radiofrequency current. Modified Hartel's anterior appaorch for the injection of the Gasserian ganglion is utilized and the radiofrequency lesions were made in the second branches of the trigeminal nerve selectively preserving the touch sensation in our patients. We reviewed the literature and described the technical procedures.