Cordotomy Procedures Research Articles

Transverse Cordotomy with Thyroarytenoid Myectomy for Bilateral Vocal Fold Immobility.

We propose a modification of the transverse cordotomy procedure which improves the predictable airway outcome and allows for better voice. Laryngoscope, 134:2790-2792, 2024.

Effectiveness of CT-guided percutaneous cordotomy in intractable cancer pain: Experience in 14 patients.

Severe and treatment-resistant pain is a major issue for patients with cancer. Cordotomy is an effective approach for addressing severe cancer-related pain. It is based on blocking the transmission of pain by damaging the lateral spinothalamic tract. Computed tomography guided cordotomy was performed on 14 patients who did not respond to medical and interventional pain management methods. Fourteen patients with cancer pain underwent CT-guided percutaneous cordotomy. Pain relief was reported in 86% of the patients. The visual analog scale values before and after cordotomy were compared and a significant difference was found (p = 0.0001). The improvement in the Karnofsky Performance Scale score of the patients was found to be statistically significant (p = 0.0001). We believe that CT-guided cordotomy, performed by experienced hands in a team of experienced individuals and applied to the right patients, is an effective treatment. However, it is crucial to exercise extreme caution regarding potential side effects and serious complications during the cordotomy procedure.

Intraoperative Neurophysiology for Optimization of Percutaneous Spinothalamic Cordotomy for Intractable Cancer Pain.

Percutaneous ablation of the cervical spinothalamic tract (STT) remains a therapeutic remedy for intractable cancer pain. However, it is accompanied by the risk of collateral damage to essential spinal cord circuitry, including the corticospinal tract (CST). Recent studies describe threshold-based mapping of the CST with the objective of motor bundle preservation during intramedullary spinal cord and supratentorial surgery. To assess the possibility that application of spinal cord mapping using intraoperative neuromonitoring in percutaneous cordotomy procedures may aid in minimizing iatrogenic motor tract injury. We retrospectively reviewed the files of 11 patients who underwent percutaneous cervical cordotomy for intractable oncological pain. We performed quantitative electromyogram (EMG) recordings to stimulation of the ablation needle prior to the STT-ablative stage. We compared evoked motor and sensory electrical thresholds, and the electrical span between them as a reliable method to confirm safe electrode location inside the STT. Quantified EMG data were collected in 11 patients suffering from intractable cancer pain. The threshold range for evoking motor activity was 0.3 to 1.2 V. Stimulation artifacts were detected from trapezius muscles even at the lowest stimulation intensity, while thenar muscles were found to be maximally sensitive and specific. The minimal stimulation intensity difference between the motor and the sensory threshold, set as "Δ-threshold," was 0.26 V, with no new motor deficit at 3 days or 1 month postoperatively. Selective STT ablation is an effective procedure for treating intractable pain. It can be aided by quantitative evoked EMG recordings, with tailored parameters and thresholds.

O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Background: Pain is often one of the most debilitating symptoms in patients with advanced oncological disease. Patients with localized pain due to malignancy refractory to medical treatment can benefit from selective percutaneous cordotomy that disconnects the ascending pain fibers in the spinothalamic tract. Objectives: Over the past year, we have been performing percutaneous radiofrequency cordotomy with the use of the O-Arm intraoperative imaging system that allows both 2D fluoroscopy and 3D reconstructed computerized tomography imaging. We present our experience using this technique, focusing on technical nuances and complications. Methods: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy between March 2016 and March 2017. Results: Nineteen patients underwent percutaneous cordotomy procedures. Two patients developed intraoperative delirium and were unable to tolerate the procedure. In 16 out of 17 completed procedures, we achieved excellent immediate pain relief (94%). At 1 month after operation, 15 of the 17 (88%) patients were pain free, and at 3 months 5 out of 5 patients available for follow-up were still free of their original pain. Mirror pain developed in 6 of the 17 patients (35%), but was mild in 4 of these cases and controlled with medications. We experienced 1 serious complication (6%) of ipsilateral hemiparesis. Conclusion: Percutaneous cordotomy using the O-Arm is safe and effective in the treatment of intractable oncological pain.

Intraoperative Neurophysiological Monitoring (IONM) for Cordotomy Procedures

ABSTRACTThis case illustrates the benefits of utilizing intraoperative neurophysiological monitoring (IONM) for preventing injury to sensory/motor pathways of the spinal cord during a cordotomy procedure to relieve pain. Cordotomy has been used effectively in the treatment of visceral pain but comes with a high risk of damaging motor and sensory pathways due to close proximity of lesion.The subject is a 47-year-old female with a pancoast tumor of the left lung, left brachial plexopathy, and severe neuropathic pain syndrome, refractory to medical therapy. A palliative cordotomy procedure was elected for pain control.Baseline bilateral posterior tibial and median nerve somatosensory evoked potentials (SSEP) were present except in the left upper extremity. Transcranial electric motor evoked potential (TCeMEP) baselines were present in all extremities except the left upper. Total intravenous anesthesia was used. The spine was exposed at C2–C3 and a right single anterolateral cordotomy was performed with an immediate drop in TCeMEPs (70–80% amplitude reduction) in the right upper and right lower extremities. The surgeon decided to stop the cordotomy at that point.Postoperatively, the patient had no sensory or motor deficit. In this patient, TCeMEPs were used effectively to guide the surgeon in preventing damage to the spinal cord that could lead to motor deficits.

Cordotomy procedures for cancer pain: A discussion of surgical procedures and a review of the literature

Cordotomy procedures for cancer pain: A discussion of surgical procedures and a review of the literature

Ct-guided percutaneous cordotomy for intractable pain in what is more than a disease: lung malignancies

Lung cancer is the leading cause of cancer-related mortality worldwide. Pain is a common problem in these patients, yet inadequate or dissatisfactory management is prevalent. Between 1987 and 2012, 224 patients with intractable pain were treated with computerized tomography (CT)- guided cordotomy. Among them, 210 had intractable pain due to malignancies. The majority of the cases were diagnosed as pulmonary malignancies (108 patients). Sixty-seven were pulmonary carcinoma, 26 mesothelioma and 15 Pancoast tumors. After cordotomy, 98.13% of cancer patients reported initial pain relief. Minimum and maximum preoperative scores of the Karnofsky Performance Scale were 20 and 70, versus postoperative scores of 40 and 90 (p < 0.001). The median preoperative VAS score was 8 (6-9). On the first postoperative day, the score dropped sharply to 0 (0-8) (p < 0.001). In this selected series of 108 percutaneous cordotomy procedures, as well as in the total series of 224 patients, there was no mortality or major morbidity. CT-guided percutaneous cordotomy is an effective procedure that should be used in the treatment of cancer-related pain problems. We suggest that cordotomy should be preferred as soon as possible in patients who fail to respond to the classic analgesic therapy.

Bilateral high-level percutaneous cervical cordotomy in cancer pain due to lung cancer: a case report

Background Computed tomography–guided high-level percutaneous cordotomy has been used unilaterally or bilaterally for the treatment of localized intractable pain in malignancies. Case Description A 57-year-old man was admitted to the hospital with the complaint of intractable pain involving the left side of the chest, axillary region, and shoulder. He was operated for small cell lung cancer on the left side in December 2003 and received radiotherapy and chemotherapy. His neurological examination was normal. Magnetic resonance imaging of the thorax revealed contrast-enhancing lesions on the left side extending to mediastinum and pleura. His pain was relieved completely after the first cordotomy procedure, and he was discharged from the hospital on the second postoperative day. The patient was readmitted to the hospital with the complaint of severe unilateral chest pain like the initial pain on the right side 4 days after cordotomy. The CT-guided bilateral high-level percutaneous cordotomy was performed with a 15-day interval. Conclusion The CT-guided bilateral high-level percutaneous cordotomy can be used in the treatment of intractable upper trunk pain in patients with cancer without pulmonary dysfunction.

Percutaneous Computed Tomography-Guided Transdiscal Low Cervical Cordotomy for Cancer Pain as a Method to Avoid Sleep Apnea

Objective: Study of percutaneous computed tomography (CT)-guided transdiscal low cervical cordotomy undertaken to treat pain in cancer patients. Methods: At the Department of Neurosurgery, Ain Shams University, Cairo, Egypt, 8 cancer pain patients, with either impaired pulmonary function or a previous cordotomy on an opposite side (sleep apnea was a feared complication) that prevented the possibility of undergoing a C_1–2 cordotomy, underwent a percutaneous CT-guided transdiscal low cervical cordotomy (C_4–5 or C_5–6) to treat cancer pain. Results: Seven patients experienced initial improvement. One patient re-experienced pain within 2 weeks and 1 patient experienced no pain relief. In 6 patients in whom the cordotomy procedure was completed, satisfactory or complete pain relief, throughout a 6-month follow-up period was reported. In contrast, in 2 patients in whom the cordotomy was not completed there was no persistent pain relief. Conclusion: Percutaneous CT-guided cordotomy remains a successful procedure to control pain in cancer patients, and is an affordable viable option under circumstances where economic disadvantage is an overriding determinate.