Endoscopic-guided percutaneous radiofrequency cordotomy


Autoria(s): FONOFF, Erich Talamoni; OLIVEIRA, Ywzhe Sifuentes Almeida de; LOPEZ, William Omar Contreras; ALHO, Eduardo Joaquim Lopes; LARA, Nilton Alves; TEIXEIRA, Manoel Jacobsen
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

19/10/2012

19/10/2012

2010

Resumo

The authors present the first clinical implementation of an endoscopic-assisted percutaneous anterolateral radiofrequency cordotomy. The aim of this article is to demonstrate the intradural endoscopic visualization of the cervical spinal cord via a percutaneous approach to refine the spinal target for anterolateral cordotomy, avoiding undesired trauma to the spinal tissue or injury to blood vessels. Initially, a lateral puncture of the spinal canal in the C1-2 interspace is performed, guided by fluoroscopy. As soon as CSF is reached by the guide cannula (17-gauge needle), the endoscope can be inserted for visualization of the spinal cord and its surrounding structures. The endoscopic visualization provided clear identification of the pial surface of the spinal cord, arachnoid membrane, dentate ligament, dorsal and ventral root entry zone, and blood vessels. The target for electrode insertion into the spinal cord was determined to be the midpoint from the dentate ligament and the ventral root entry zone. The endoscopic guidance shortened the fluoroscopy usage time and no intrathecal contrast administration was needed. Cordotomy was performed by a standard radiofrequency method after refining of the neurophysiological target. Satisfactory analgesia was provided by the procedure with no additional complications or CSF leak. The initial use of this technique suggests that a percutaneous endoscopic procedure may be useful for particular manipulation of the spinal cord, possibly adding a degree of safety to the procedure and improving its effectiveness. (DOI: 10.3171/2010.4.JNS091779)

Identificador

JOURNAL OF NEUROSURGERY, v.113, n.3, p.524-527, 2010

0022-3085

http://producao.usp.br/handle/BDPI/22980

10.3171/2010.4.JNS091779

http://dx.doi.org/10.3171/2010.4.JNS091779

Idioma(s)

eng

Publicador

AMER ASSOC NEUROLOGICAL SURGEONS

Relação

Journal of Neurosurgery

Direitos

restrictedAccess

Copyright AMER ASSOC NEUROLOGICAL SURGEONS

Palavras-Chave #pain #cancer #percutaneous cordotomy #spinal endoscopy #radiofrequency #spinal cord #DIRECT VISUALIZATION #Clinical Neurology #Surgery
Tipo

article

original article

publishedVersion