title: Microendoscopy-guided percutaneous cordotomy for intractable pain: case series of 24 patients.
abstract: OBJECTIVE
  The aim of this study was to show that microendoscopic guidance using a double-channel technique could be safely applied during percutaneous cordotomy and provides clear real-time visualization of the spinal cord and surrounding structures during the entire procedure.
  
  
  METHODS
  Twenty-four adult patients with intractable cancer pain were treated by microendoscopic-guided percutaneous radiofrequency (RF) cordotomy using the double-channel technique under local anesthesia. A percutaneous lateral puncture was performed initially under fluoroscopy guidance to localize the target. When the subarachnoid space was reached by the guiding cannula, the endoscope was inserted for visualization of the spinal cord and surrounding structures. After target visualization, a second needle was inserted to guide the RF electrode. Cordotomy was performed by a standard RF method.
  
  
  RESULTS
  The microendoscopic double-channel approach provided real-time visualization of the target in 91% of the cases. The other 9% of procedures were performed by the single-channel technique. Significant analgesia was achieved in over 90% of the cases. Two patients had transient ataxia that lasted for a few weeks until total recovery.
  
  
  CONCLUSIONS
  The use of percutaneous microendoscopic cordotomy with the double-channel technique is useful for specific manipulations of the spinal cord. It provides real-time visualization of the RF probe, thereby adding a degree of safety to the procedure.
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil; and.
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil; and.|Department of Stereotactic and Functional Neurosurgery, University Medical Center, Freiburg, Germany.
authors.forename: William Omar Contreras
authors.initials: WO
authors.lastname: Lopez
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil; and.
authors.forename: Ywzhe Sifuentes Almeida
authors.initials: YS
authors.lastname: de Oliveira
authors.affiliation: Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Brazil; and.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D000368:Aged; D002818:Cordotomy / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009369:Neoplasms / Q000150:complications; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011846:Radio Waves; D013116:Spinal Cord / Q000601:surgery; D013133:Spinothalamic Tracts / Q000033:anatomy & histology / Q000601:surgery; D013346:Subarachnoid Space / Q000033:anatomy & histology / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: PCC = percutaneous cervical cordotomy; RF = radiofrequency; STT = spinothalamic tract; VAS = visual analog scale; cancer; endoscopy; minimally invasive neurosurgery; pain; percutaneous cordotomy; radiofrequency; spinal cord; spinal endoscopy; spinothalamic tract; surgical technique