Microendoscopy-guided percutaneous cordotomy for intractable pain: case series of 24 patients

Author(s)

Fonoff, Erich Talamoni ^{[1, 2]} ; Contreras Lopez, William Omar ^{[1, 2, 3]} ; Almeida de Oliveira, Ywzhe Sifuentes ^{[1, 2]} ; Teixeira, Manoel Jacobsen ^{[1, 2]}

Affiliation

^[1] Univ Sao Paulo, Sch Med, Pain Ctr, BR-05508 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Dept Neurol, Div Funct Neurosurg, BR-05508 Sao Paulo - Brazil

^[3] Univ Med Ctr, Dept Stereotact & Funct Neurosurg, Freiburg - Germany

• Document type: Journal article
• Source: JOURNAL OF NEUROSURGERY; v. 124, n. 2, p. 389-396, FEB 2016.
• Web of Science Citations: 1

Abstract

OBJECTIVE The aim of this study was to show that microendoscopic guidance using a double-channel technique could be safely applied during percutaneous cordotomy and provides clear real-time visualization of the spinal cord and surrounding structures during the entire procedure. METHODS Twenty-four adult patients with intractable cancer pain were treated by microendoscopic-guided percutaneous radiofrequency (RF) cordotomy using the double -channel technique under local anesthesia. A percutaneous lateral puncture was performed initially under fluoroscopy guidance to localize the target. When the subarachnoid space was reached by the guiding cannula, the endoscope was inserted for visualization of the spinal cord and surrounding structures. After target visualization, a second needle was inserted to guide the RF electrode. Cordotomy was performed by a standard RF method. RESULTS The microendoscopic double -channel approach provided real-time visualization of the target in 91% of the cases. The other 9% of procedures were performed by the single -channel technique. Significant analgesia was achieved in over 90% of the cases. Two patients had transient ataxia that lasted for a few weeks until total recovery. CONCLUSIONS The use of percutaneous microendoscopic cordotomy with the double-channel technique is useful for specific manipulations of the spinal cord. It provides real-time visualization of the RF probe, thereby adding a degree of safety to the procedure. (AU)

• FAPESP's process: 11/08529-5 - Double-blind controlled study on the effect of ozone applied for spinal endoscopy in the treatment of post-laminectomy pain syndrome: differential analysis in neuropathic and non-neuropathic pain and its correlation with the level of epidural cytokines
• Grantee: Erich Talamoni Fonoff
• Support Opportunities: Regular Research Grants