Endoscopic-guided percutaneous radiofrequency cordotomy.
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.
Fonoff
Erich Talamoni
ET
Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil. fonoffet@usp.br
de Oliveira
Ywzhe Sifuentes Almeida
YS
Lopez
William Omar Contreras
WO
Alho
Eduardo Joaquim Lopes
EJ
Lara
Nilton Alves
NA
Teixeira
Manoel Jacobsen
MJ
D002574:Cervical Vertebrae; D002818:Cordotomy / Q000379:methods*; D004566:Electrodes; D005471:Fluoroscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D010148:Intractable Pain / Q000601:surgery; D011846:Radio Waves; D013116:Spinal Cord / Q000601:surgery; D013997:Time Factors