Computed Tomography-Guided Percutaneous Cordotomy for Intractable Pain in Malignancy

Abstract

In the treatment of intractable pain, CT-guided cordotomy is an option in specially selected cases with malignancy. In this study, anatomic and technical details of the procedure and the experience gained from treating 207 patients over a 20-year period are discussed.

Percutaneous cervical cordotomy in cancer pain

“…Kanpolat et al [10,29,30] described more than 200 patients with intractable pain with pulmonary carcinoma, mesothelioma and Pancoast tumours, and Yequl et al [15] described CT-guided percutaneous cordotomy as a useful procedure for the treatment of severe unilateral cancer pain syndromes. Conventional percutaneous cordotomy with X-ray visualisation is a much less invasive procedure, allowing safe unilateral operations at the high cervical level, but bilateral lesions high in the cervical spinal cord involving the anterior portion of the lateral spinothalamic tract have been associated with sleep-induced apnoea due to bilateral destruction of the ventrolateral reticulospinal tract [16,17,30,31].…”

Ct-guided high level percutaneous cervical cordotomy for intractable cancer pain

“…In a prospective study, Price et al reported that (2,12,28). We observed none of these complications in our series.…”

“…The surgical procedure was performed as described before by Kanpolat et al (5,6,8,12). The procedure was performed in a computed tomography unit.…”

“…Before the procedure, the dimensions of the spinal cord were determined for each patient. Iohexol (7-8 mL, 240 mg/mL) was administered 20 to 30 minutes before the operation intrathecally (5,12). After the local anesthetic agent, the cordotomy needle was inserted inferior to the mastoid process in the vertical plane perpendicular to the axis of the spinal cord (12).…”

“…the ideal position for cannula was determined. The ideal localization of the cannula tip was 1 mm anterior to the denticulate ligament for lumbosacral fibers and 2 to 3 mm anterior to the denticulate ligament for thoracic and cervical fibers after the puncture (9,12). The needle was in the ideal position if it is nearly perpendicular to the spinal cord.…”