Endoscopic Approaches to the Spinal Cord

  • Erich Talamoni Fonoff
  • William Omar Contreras Lopez
  • Ywzhe Sifuentes Almeida de Oliveira
  • Nilton Alves Lara
  • Manoel Jacobsen Teixeira
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 108)


Minimally invasive procedures have been used to treat various diseases in medicine. Great improvements in these techniques have provided intraventricular, transnasal and more recently cisternal intracranial accesses used to treat different conditions. Endoscopic approaches have been proposed for the treatment of disk herniation or degenerative disease of the spine with great progress in the recent years. However the spinal cord has not yet been reached by video-assisted procedures. This article describes our recent experience in procedures to approach the spinal cord itself in order to provide either diagnosis by tissue biopsies or inducing radiofrequency spinal ablation to treat chronic pain syndromes. We describe three different approaches proposed to provide access to the entire length of the spinal canal from the cranium–cervical transition, cervico-thoracic canal (spinal cord and radiculi) to the lumbar-sacral intraraquidian structures (conus medularis and sacral roots). We idealized the use of endoscopy to assist cervical anterolateral cordotomies and trigeminal nucleotractotomies, avoiding the use of contrast medium as well as vascular injuries and consequent unpredictable neurological deficits. This technique can also provide minimally invasive procedures to possibly treat spasticity through selective rhizotomies, assist catheter placements in the lumbar canal or debridation of adherences in cystic syringomyelia and arachnoid cysts, providing normalization of CSF flow.


Cordotomies Endoscopy Rhizotomies Spinal cord 


Conflict of interest statement We declare that we have no conflict of interest.


  1. 1.
    Dandy WE (1929) Loose cartilage from intervertebral disc simulating tumor of the spinal cord. Arch Surg 19:660–72CrossRefGoogle Scholar
  2. 2.
    Burman MS (1931) Myeloscopy or the direct visualization of the spinal cord and its contents. J Bone Joint Surg 13:695–6Google Scholar
  3. 3.
    Pool JL (1942) Myeloscopy, intraspinal endoscopy. Surgery 11:169–82Google Scholar
  4. 4.
    Ooi Y, Sato Y, Morisaki N (1973) Myeloscopy: the possibility of observing the lumbar intrathecal space by use of an endoscope. Endoscopy 5:901–6CrossRefGoogle Scholar
  5. 5.
    Olinger CP, Ohlhaber RL (1974) Eighteen-gauge microscopic-telescopic needle endoscope with electrode channel: potential clinical and research application. Surg Neurol 2:151–60PubMedGoogle Scholar
  6. 6.
    Falconer MA (1949) Intratuedullary trigeminal tractotomy and its place in the treatment of facial pain. J Neurol Neurosurg Psychiatry 12:297–311PubMedCrossRefGoogle Scholar
  7. 7.
    Fox JL (1971) Intractable facial pain relieved by percutaneous trigeminal tractotomy. JAMA 218:1940–1PubMedCrossRefGoogle Scholar
  8. 8.
    Hitchcock E (1970) Stereotactic trigeminal tractotomy. Ann Clin Res 2:131–5PubMedGoogle Scholar
  9. 9.
    Teixeira MJ, Fonoff ET (2009) Technique of Trigeminal Nucleotractotomy. In Tasker R, Lozano A, Gildenbeg P (ed) Stereotactic and Functional Neurosurgery. Springer-Verlag, Berlin/Heidelberg, pp 2097–124CrossRefGoogle Scholar
  10. 10.
    Kanpolat Y, Deda H, Akyar S, et al (1989) CT-guided trigeminal tractotomy. Acta Neurochirurg (Wien) 100:112–4CrossRefGoogle Scholar
  11. 11.
    Lukas A (2008) Adhesive arachnoiditis following percutaneous cervical cordotomy. May we still use lipiodol? J Pain Symptom Manage 5:36Google Scholar
  12. 12.
    Rosomoff HL, Carroll F, Brown J, et al (1965) Percutaneous radiofrequency cervical cordotomy: technique. J Neurosurg 23:639–44PubMedCrossRefGoogle Scholar
  13. 13.
    Rosomoff HL, Sheptak P, Carroll P (1966) Modern pain relief: percutaneous cordotomy. JAMA 196:482–486PubMedCrossRefGoogle Scholar
  14. 14.
    Amano K, Kawamura H, Tanikawa T, et al (1991) Bilateral versus unilateral percutaneous high cervical cordotomy as a surgical method of pain relief. Acta Neurochir Suppl 52:143–5CrossRefGoogle Scholar
  15. 15.
    Belmusto L, Brown E, Owens G (1963) Clinical observations on respiratory and vasomotor disturbance as related to cervical cordotomies. J Neurosurg 20:225–32PubMedCrossRefGoogle Scholar
  16. 16.
    Hitchcock E, Leece B (1967) Somatotopic representation of the respiratory pathway in the cervical cord of pain. J Neurosurg 27:320–9PubMedCrossRefGoogle Scholar
  17. 17.
    Kanpolat y, Akyar S, Caglar S (1995) Diametral measurements of the upper spinal cord for stereotactic pain procedures: experimental and clinical study. Surg Neurol 34:478–83Google Scholar

Copyright information

© Springer-Verlag/Wien 2011

Authors and Affiliations

  • Erich Talamoni Fonoff
    • 1
  • William Omar Contreras Lopez
    • 1
  • Ywzhe Sifuentes Almeida de Oliveira
    • 1
  • Nilton Alves Lara
    • 1
  • Manoel Jacobsen Teixeira
    • 1
  1. 1.Division of Functional NeurosurgeryDepartment of Neurology of School of Medicine of University of São PauloSão PauloBrazil

Personalised recommendations