Strauss Ido, Berger Assaf, Arad Michal, Hochberg Uri, Tellem Rotem
Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Stereotact Funct Neurosurg. 2017;95(6):409-416. doi: 10.1159/000484614. Epub 2018 Jan 10.
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.
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.
A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy between March 2016 and March 2017.
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.
Percutaneous cordotomy using the O-Arm is safe and effective in the treatment of intractable oncological pain.
疼痛往往是晚期肿瘤疾病患者最使人衰弱的症状之一。因恶性肿瘤导致局部疼痛且药物治疗无效的患者可从选择性经皮脊髓切开术中获益，该手术可切断脊髓丘脑束中的上行痛觉纤维。
在过去一年中，我们一直在使用O型臂术中成像系统进行经皮射频脊髓切开术，该系统可同时进行二维荧光透视和三维重建计算机断层扫描成像。我们介绍使用该技术的经验，重点关注技术细节和并发症。
对2016年3月至2017年3月期间所有接受经皮脊髓切开术的患者进行回顾性分析。
19例患者接受了经皮脊髓切开术。2例患者术中出现谵妄，无法耐受手术。在17例完成的手术中，16例（94%）术后立即获得了极佳的疼痛缓解效果。术后1个月，17例患者中有15例（88%）无疼痛，术后3个月，5例可进行随访的患者中仍有5例无原发病灶疼痛。17例患者中有6例（35%）出现镜像疼痛，但其中4例较轻，可通过药物控制。我们经历了1例严重并发症（6%），即同侧偏瘫。
使用O型臂进行经皮脊髓切开术治疗顽固性肿瘤疼痛安全有效。
