Department of Neurological Surgery, Oregon Health & Science University, 3303 Southwest Bond Avenue, Portland, OR 97239, USA.
Curr Pain Headache Rep. 2010 Dec;14(6):477-82. doi: 10.1007/s11916-010-0135-5.
Neurosurgical procedures to treat pain are mainly destructive and involve the spinal cord and occasionally the brain. Targets include the spinothalamic tract, the trigeminal tract nucleus, the midline ascending visceral pain pathway, the brainstem spinal lemniscus, the thalamus, and the cingulate gyrus. Since the introduction of intrathecal opioids, the need for neurosurgical destructive procedures has been in decline. In recent years, cordotomy, trigeminal tractotomy, and dorsal root entry zone (DREZ) operations are the neurosurgical procedures most often utilized to treat cancer pain. The addition of CT guidance to spinal cord pain pathway ablation was a major addition and refinement to the procedure. Here the authors review the latest techniques and recently published results for CT-guided cordotomy, CT-guided trigeminal tractotomy, and DREZ operations utilized to treat cancer pain.
神经外科手术主要用于治疗疼痛，主要涉及脊髓，偶尔也涉及大脑。靶点包括脊髓丘脑束、三叉神经束核、中线内脏上行疼痛通路、脑干脊髓丘系、丘脑和扣带回。自从鞘内阿片类药物问世以来，神经外科破坏性手术的需求一直在下降。近年来，脊髓切开术、三叉神经束切开术和背根入口区（DREZ）手术是治疗癌症疼痛最常采用的神经外科手术。将 CT 引导技术应用于脊髓疼痛通路消融是该手术的一个重大补充和改进。本文作者回顾了用于治疗癌症疼痛的 CT 引导脊髓切开术、CT 引导三叉神经束切开术和 DREZ 手术的最新技术和最近发表的结果。
