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DREZotomie

  • Jean-Baptiste ThiébautEmail author
  • Vincent d’Hardemare
  • Anne Margot-Duclot
  • Bénédicte Silhouette

Résumé

La DREZotomie est le nom donné à l’ensemble des interventions effectuées dans la zone s’étendant de la terminaison des racines postérieures aux cornes postérieures de la moelle et comprenant les voies sensitives périphériques, les « 2es neurones » stratifiés en couche et différentes voies centrales activatrices et inhibitrices qui contrôlent ces neurones. En 1972, Sindou a été le précurseur de cette chirurgie en effectuant la première radicellotomie sélective [1]. Basée sur des travaux anatomiques, cette intervention avait pour objectif d’interrompre les fibres nociceptives de petit diamètre dans le cadre du traitement des douleurs de cancer comme le syndrome de Pancoast. Sindou va aussi opérer des patients présentant des douleurs neuropathiques, mais c’est Nashold qui, en 1975, présente les premiers résultats obtenus dans les douleurs d’avulsion du plexus brachial par thermocoagulation des cornes postérieures de la moelle dans une publication intitulée « Focal destruction of substantia gelatinosa of Rolando » [2]. Un seul terme, la DREZotomie, a été retenu pour identifier ces deux interventions qui sont pourtant bien différentes. L’une porte sur les voies terminales du neurone sensitif périphérique alors que l’autre consiste à détruire sur le versant central les 2es neurones désafférentés à l’origine de douleurs neuropathiques. Ces deux interventions, destruction des cornes postérieures et radicellotomie sélective, doivent être étudiées séparément car la technique opératoire et surtout les indications leur sont propres (Fig. 1).

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Copyright information

© Springer-Verlag Paris 2014

Authors and Affiliations

  • Jean-Baptiste Thiébaut
    • 1
    Email author
  • Vincent d’Hardemare
    • 1
  • Anne Margot-Duclot
    • 1
  • Bénédicte Silhouette
    • 1
  1. 1.Service de neurochirurgie et CETDFondation RothschildParisFrance

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