Abstract
At present, inspite of increased variety and effectiveness of the avaible drugs and less invasive procedures like neurostirnulation and intratechallintraventricular adrninistration of morphine, neurodestructive surgery remains as the most widely used method of treatment in the control of intractable pain. Spinal cord is the most preferred part of the central nervous system in destructive pain surgery. In open surgery radio frequency or laser lesions can be used for destruction ofthe targets, in addition to the classical surgical knife. Percutaneous stereotactic procedures, which is our topic are the most efficient ones. The main advantages of these methods are producing precise lesions and maintaining good communication with the patient during the procedure. Percutaneous stereotactic destructive pain surgery consists of localization and destruction of a target by a special needle electrode system. (21) Within this system R. F. thermocoagulation is the mostly used destructive lesion into the target. At the target level plain X-rays are insufficient to visualize directly the target-electrode relation even with contrast agents. This problem is completely solved with the use of computed tomography. CT guidance demostrate the target-electrode relationship directly and also give us the additional information of the size and relative displacement of the spinal cord within the spinal canal. (8.9. 10) Ability of stimulation of the target, impedence measurements and neurophysological recording, are incorporated with the needle-electrode which system makes it a most useful tool in performing efficient safe lesions. The wide diversity of the pain fibers within the spinal cord and their different localization in different modalities ofpain presents the problem ofchosing the correct target for the different types of pain. This is prerequisite in the successful surgical treatment of the pain. In this report I shall present neurodestructive methods in the spinal cord and try to convey my philosphy based on my surgical experience. DREZ OPERATION:
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