Acta Neurochirurgica

, Volume 18, Issue 4, pp 309–317 | Cite as

Percutaneous stereotaxic cordotomy

I. Problems encountered
  • J. L. Fox
Article

Summary

Out of an initial series of 50 percutaneous anterolateral cordotomies the following complications occurred due to correctable errors in technique: hemiplegia (2), respiratory arrest with quadriplegia and death (1), transient hypotensive shock (1), and fatal apnea (3). Since these represent problems which other neurosurgeons may encounter while gaining experience in this technique for pain relief, the mechanism of the problem and its avoidance is detailed.

Control of the needle-electrode with respect to the anterior spinal artery and the dentate ligament is essential. Patients with low hematocrit and low blood volume should be transfused prior to cordotomy. It is the opinion of this author that a) reduced pulmonary function and b) previous contralateral upper cervical cordotomy are contraindications to upper cervical percutaneous cordotomy. In such situations low cervical cordotomy by the anterior, transdiscal approach is preferable in the hands of this author.

Keywords

Hemiplegia Quadriplegia Anterior Spinal Artery Hypotensive Shock Dentate Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Zusammenfassung

In einer anfänglichen Serie von 50 perkutan durchgeführten anterolateralen Chordotomien traten folgende Komplikationen auf, die auf vermeidbaren technischen Fehlern beruhten: Hemiplegie (2), Atemstillstand mit Tetraplegie und Tod (1), vorübergehender hypotensiver Schock (1), tödliche Apnoe (3). Weil diese Komplikationen auf Problemen beruhen, die auch anderen Neurochirurgen begegnen können, während sie mit dieser Methode der Schmerzbeseitigung Erfahrungen sammeln, wird im einzelnen auf den Mechanismus der Schwierigkeiten und die Möglichkeiten der Vermeidung eingegangen.

Wesentlich ist die Kontrolle der Nadelelektrode im Hinblick auf die A. spinalis anterior und das Ligamentum denticulatum. Bei Patienten mit niedrigem Hämatokrit und niedrigem Blutvolumen sollen vor der Chordotomie Transfusionen durchgeführt werden. Nach Ansicht der Autoren sind a) verminderte Lungenfunktion und b) eine vorangegangene kontralaterale obere zervikale Chordotomie Kontraindikationen für die Durchführung einer hohen zervikalen perkutanen Chordotomie. In solchen Situationen ist die tiefe zervikale Chordotomie vom vorderen transdiskalen Zugang nach den Erfahrungen des Autors vorzuziehen.

Résumé

Les complications suivantes, dues à des erreurs de techniques facilement corrigeables, furent rencontrées dans une série de 50 cordotomies antérolatérales: hémiplégie (2), arrêt respiratoire avec quadriplégie et décès (1), hypotension transitoire (1) et apnée fatale (3).

L'auteur discute longuement le mécanisme de production de ces complications de même que les moyens de les éviter parce que ce sont là des problèmes rencontrés par tout neurochirurgien qui cherche à devenir familier avec cette technique.

La position de l'aiguille électrode par rapport à l'artère spinale antérieure et le ligament dentelé doit être rigoureusement controlés. On devrait transfuser les patients dont l'hématocrite et le volume sanguin est diminué.

L'auteur est d'avis que la cordotomie percutanée cervicale est contre indiquée chez les patients dont la fonction pulmonaire est diminuée et chez ceux qui ont antérieurement subi une cordotomie cervicale haute controlatérale. Dans ces cas on devrait faire une cordotomie cervicale basse par voie antérieure à travers le disque intervertébrál.

Riassunto

Nell'effettuare una serie iniziale di 50 cordotomie percutanee anterolaterali si verificarono le seguenti complicazioni, dovute ad errori di tecnica emendabili: emiplegia (2), arresto respiratoriocon quadriplegia e morte (1), shock ipotensivo transitorio (1), apnea letale (3). Siccome si trat ta di problemi che possono presentarsi ad altri neurochirurghi nello sperimentare questa tecnica antalgica, l'A. espone il meccanismo dei problemi stessi ed i mezzi per evitarli.

E' di importanza essenziale regolare l'elettrodo ad ago, avendo riguardo all'arteria spinale anteriore ed al legamento dentato. Ai pazienti che presentino basse quantità di emazie e di sangue vanno praticate trasfusioni sanguigne prima dell'operazione. E' opinione dell'A. che a) una funzionalità polmonare inefficiente e b) una precedente cordotomia cervicale controlaterale superiore costituiscano controindicazione per la cordotomia cervicale superiore percutanea e che in tali casi sia preferibile praticare una cordotomia cervicale inferiore con attacco anteriore transdiscale.

Resumen

En una primera serie de 50 cordotomias anterolaterales percutaneas realizadas, se presentaron las siguientes complicaciones debidas a faltas técnicas evitables: Hemiplejía (2), Apnea con tetraplejía y muerte (1), Schock hipotensivo pasajero (1), Apnea mortal (3). Puesto que estas complicaciones dependen de problemas que tambien pueden presentarse a otros neurocirujanos, durante el periodo en que estos adquieren experiencia con este método de supresión del dolor, se trata de forma detallada el mecanismo de las dificultades y las posibilidades de evitarlas.

Importante es el control de la aguja del electrodo en relación a la A. espinal anterior y al ligamento dentado. En pacientes con hematocrito bajo y reducido volumen sanguineo. En opinión de los autores para la practica de una cordotomia cervical alta percutanea son contraindicaciones, a) una disminución de la función pulmonar y b) una cordotomia cervical alta contralateral practicada con anterioridad. Según la experiencia de los autores, en tales situaciónes, es de elgir la cordotomia cervical baja de acceso transdiscal anterior.

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Copyright information

© Springer-Verlag 1968

Authors and Affiliations

  • J. L. Fox
    • 1
    • 2
  1. 1.Neurosurgical Section of the Veterans Administration HospitalUSA
  2. 2.George Washington University School of MedicineWashington, D. C.

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