Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Neurosurgery. 2018 Oct 1;83(4):783-789. doi: 10.1093/neuros/nyx549.
Limited midline myelotomy targets the midline nociceptive pathway for intractable visceral pain. Multiple techniques are available for limited midline myelotomy; however, outcome data for each technique are sparse.
To review our experience with open and percutaneous approaches for limited midline myelotomy for intractable visceral pain.
Patients who underwent limited midline myelotomy for intractable visceral pain were reviewed. Myelotomy was performed using 3 techniques: open limited myelotomy, percutaneous radiofrequency myelotomy, and percutaneous mechanical myelotomy. Demographic and perioperative clinical data were recorded. In addition to the visual analog scale and Karnofsy performance score, outcomes were categorized as excellent (no pain), good (considerable reduction in pain, not requiring opioids stronger than codeine), fair (minimal reduction in pain, but no change in opioid medication requirement), and poor (no reduction in pain).
Eight patients (median age 56.5 yr, 6 females) underwent limited myelotomy. Four patients underwent open limited thoracic myelotomy with excellent pain outcomes. Three patients underwent percutaneous radiofrequency lesioning with fair (n = 1) and poor outcomes (n = 2). One patient underwent percutaneous mechanical lesioning with a good outcome (n = 1). The median duration of follow-up was 11 wk (2-54 wk). Two patients reported minor sensory complications after the procedure.
In our preliminary experience, outcomes for open limited thoracic myelotomy were superior to percutaneous approaches. Given the limited utilization of this technique, multicenter registries are needed to further evaluate the best surgical technique for limited midline myelotomy.
有限中线切开术针对难治性内脏疼痛的中线伤害感受通路。有多种技术可用于有限中线切开术；然而，每种技术的结果数据都很有限。
回顾我们使用开放和经皮方法治疗难治性内脏疼痛的有限中线切开术的经验。
回顾接受有限中线切开术治疗难治性内脏疼痛的患者。采用 3 种技术进行切开术：开放有限切开术、经皮射频切开术和经皮机械切开术。记录了人口统计学和围手术期临床数据。除视觉模拟量表和卡诺夫斯基表现评分外，结果还分为优秀（无疼痛）、良好（疼痛明显减轻，无需比可待因更强的阿片类药物）、一般（疼痛减轻轻微，但阿片类药物需求无变化）和差（疼痛无减轻）。
8 名患者（中位年龄 56.5 岁，6 名女性）接受了有限切开术。4 名患者接受了开放有限的胸段切开术，疼痛结果良好。3 名患者接受了经皮射频消融术，结果为一般（1 例）和差（2 例）。1 名患者接受了经皮机械消融术，结果为良好（1 例）。中位随访时间为 11 周（2-54 周）。2 例患者在手术后报告了轻微的感觉并发症。
在我们的初步经验中，开放有限的胸段切开术的结果优于经皮方法。鉴于这种技术的应用有限，需要多中心登记来进一步评估有限中线切开术的最佳手术技术。
