Percutaneous cordotomy is a useful method for cancer pain management. Candidates for cervical cordotomy include those patients with unilateral cancer pain below the shoulder, with a life expectancy of less than 1 year, who can not be adequately treated by other less invasive methods. However, various complications can occur following a cordotomy, with the most serious being respiratory dysfunction. Herein, we report a case of transient respiratory dysfunction following a percutaneous cervical cordotomy.
Cordotomy* ; Humans ; Life Expectancy ; Pain Management ; Shoulder

Patients with pain syndromes resulting from recurrent or metastatic cancer should be evaluated carefully to determine the cause of their pain and the need for appropriate antitumor treatment. The most effective ablative pain control procedure at the current time is cordotomy, which is indicated in patients with unilateral pain. The authors results of 12 antero-lateral thoracic cordotomies performed for intractable cancer pain between 1996-1998. The follow-up of these patients was continued for at least 12 months or until death to determine the late success of this procedure. Excellent surgical results were obtained in 100% after one week and in 50% in 6 months after operation. The operation was considered to be successful for patients with malignant disease of short life expectancy.
Cordotomy* ; Follow-Up Studies ; Humans ; Life Expectancy

Sixty percutaneous radiofrequency cervical cordotomies were carried out in 47 patients with intractable pain from April 1973 to the end of 1978. Nintyseven % of the operations was recorded as excellent result. Complications were bladder dysfunction of 18%, which improved within about 2 weeks, except a case, and motor weakness of 15%, which improved within about 3 weeks except a case. Patients who developed postoperative respiratory difficulty already had impaired respiratory function before the operation due to the lung cancer. In conclusion percutaneous cervical radiofrequency cordotomy allows easy, efficient and low-risk relief of intractable pain with a short period of hospitalization.
Cordotomy* ; Hospitalization ; Humans ; Lung Neoplasms ; Pain, Intractable* ; Urinary Bladder

The technique of anterolateral cordotomy for relief of pain was first performed by Spiller and Martin (1912). It was accepted as the best available method for long-term relief despite its disadvantages. It has been well documented that the procedure often caused weakness of an extremity or the loss of sphincter control and respietory impairment associated with high surgical cervical cordotomy. In 1963, Mullan et al. devised an approach to the cervical spinal cord by inserting a needle through the neck under roentgenologic control. They introduced a radioactive needle (Strontium90) to produce a lesion interrupting the lateral spinothalamic tract. Mullan and Rosomoff et al. (1965) later simplified the produce by using an electrical current to produce the lesion. The percutaneous method has considerable advantages. The mortality and morbidity are very small and the technique can be used on any patient including even the terminal state. If the required level is not attained on the first attempt, or if the level subsequently drops, the procedure is easily repeated. Most patients can be discharged early after this type of cordotomy. Authors have reviewed 46 cordotomies on 35 patients with intractable pain carried out by the percutaneous radiofrequency procedure at the Neurosurgery Department of Yonsei University from 1972 to 1975:36 cases were treated by a modification of the Rosomoffs technique, 10 cases by Lin's technique. Intractable pain has been a continuing problem in neurosurgery and many methods have been employed in its treatment. The function of lateral spinothalamic tract was described by Spiller and Martin in 1912. and they described the posterior approach to the spinal cord which has been widely used for cordotomy in the 50 years since. However, in elderly or debilitated patients, this method has proved to have many complications and is poorly tolerated and has a morbidity and mortality rate. In 1963, Sean Mullan, using a Strontium90 electrode accomplished a lateral spinothalamic cordotomy by stereotaxic surgery under local anesthesia (Mullan, et al., 1963; 1965; 1965). Later, in 1965, Rosomoff (Rosomoff,et al., 1965; Rosomoff, et al., 1966) developed an improved technique using UHF radio waves, which achieved wide popularity. Using radiological equipment and measuring the impedance of various portions of the spinal cord with electrodes, the exact area of the lateral spinothalamic tract to be destroyed could be located. Utilizing localizing electrodes and the above method, complications from destruction of the tracts near the lateral spinothalamic tract which formerly resulted in hemiparesis, respiratory difficulty, urinary difficulties and other surgical difficulties could be minimized much more effectively than with open surgical approaches (Mullan and Hosobuchi, 1968). In bilateral, high cervical cordotomy the complication of sleep induced apnea may be a cause of death. Belmusto (Belmusto, et al., 1963; Belmusto; et al., 1965) indicated that the respiratory fibers are very near the lateral spinothalamic tract in the C-1 to C-3 spinal region. The respiratory fibers are located in the anterior one fourth of the spinal cord, extending from the median fissure 3~3.5 mm lateral wards towards the region of the median part of the lateral spinothalamic tract. (Mullan and Mosobuchi, 1968; Nathan, 1963; Hitchcock and Lee ce, 1967; Crosby, et al., 1962). In 1966, Lin (Lin, et al., 1966), developed a low cervical anterior approach, in order to avoid damage to the respiratory tract, and found that respiratory tract damage was actually decreased, and also found that regional analgesia was easily accomplished. Over the last three years, the authors, applying a percutaneous cervical cordotomy technique, have studied 46 patients, recording the present illness, method of surgery, postoperative analgesic area and its change with time, and complications. This material was analyzed and conclusions drawn.
Adult ; Aged ; Cordotomy/methods* ; Female ; Human ; Male ; Middle Age ; Pain, Intractable/surgery* ; Radio Waves*

The purpose of this report is to present the results of clinical observations on the surgical treatment of 26 patients (16 male, 10 female) with intractable pain during the period from May, 1960 to April, 1972 at the Department of Neurosurgery, Seoul National University Hospital. Age at the time of operation raged from 27 to 69 years. Duration of the pain from the onset to surgery was less than one year in most of the cases. The most common causes of the pain were the pelvic malignancies, lung cancer, and metastatic spine tumors in the order. In 20 cases of anterolateral cordotomies, the main complications were urinary retention, ipsilateral motor weakness, and decubitus. The high cervical cordotomy produced high analgesic level and less dropping of established analgesic level postoperatively. Posterior rhizotomy for intercostal neuralgia and a case of thoracic commissurotomy for intramedullary tumor were of gratifying result. The higher the pain located, the longer the pain existed, the operation was less likely to relieve the pain. High cervical cordotomy seems to be superior to high thoracic cordotomy even in the pain of leg, when it is considered in the respect of the high analgesic level, the lack of "island" of pain, and technical easiness.
Cordotomy ; Humans ; Leg ; Lung Neoplasms ; Male ; Neuralgia ; Neurosurgery ; Pain, Intractable* ; Rage ; Rhizotomy ; Seoul ; Spine ; Urinary Retention

STUDY DESIGN: Retrospective study. PURPOSE: To obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA). OVERVIEW OF LITERATURE: The optimal management of SCA remains controversial, and there are no standard guidelines. METHODS: The study included 20 patients with low-grade and 13 with high-grade SCA surgically treated between 1989 and 2014. Patients were classified according to the extent of surgical resection. Survival was assessed using Kaplan-Meier plots and compared between groups by log-rank tests. Neurological status was defined by the modified McCormick scale and compared between groups by Mann-Whitney U tests. RESULTS: Surgical resection was performed for 19 of 20 low-grade (95%) and 10 of 13 high-grade (76.9%) SCA patients. Only nine patients (27.3%) underwent gross total resection, all of whom had low-grade SCA. Of all patients, 51.5% showed deteriorated neurological status compared to preoperative baseline. Median overall survival was significantly longer for low-grade SCA than that (91 months, 78% at 5 years vs. 15 months, 31% at 5 years; p=0.007). Low-grade SCA patients benefited from more aggressive resection, whereas high-grade SCA patients did not. Multivariate analysis revealed histology status (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.09-0.98; p<0.05) and postoperative neurological status (HR, 0.12; CI, 0.02-0.95; p<0.05) as independent predictors of longer overall survival. Adjuvant radiotherapy had no significant impact on survival rate. However, a trend for increased survival was observed with radiation cordotomy (RCT) in high-grade SCA patients. CONCLUSIONS: Aggressive resection for low-grade and RCT may prolong survival. Preservation of neurological status is an important treatment goal. Given the low incidence of SCA, establishing strong collaborative, interdisciplinary, and multi-institutional study groups is necessary to define optimal treatments.
Astrocytoma* ; Cordotomy ; Humans ; Incidence ; Multivariate Analysis ; Prognosis* ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Spinal Cord* ; Survival Rate

Bilateral vocal cord paralysis (VCP) is a rare, life-threatening complication of stroke. We described the clinical course and treatment of bilateral VCP by acute ischemic stroke. We confirmed 4 cases of VCP. Two cases had brain-stem lesions, one case showed bilateral cerebral lesions and the last one had brainstem and cerebral lesions. One of the 4 cases showed spontaneous improvement of unilateral vocal cord function after 2 months. Among the rest, one under-went laser cordotomy, one remained tracheostomized, one was lost. (J Korean Neurol Assoc 19(4):400~403, 2001)
Brain Stem ; Cerebral Infarction ; Cordotomy ; Hoarseness ; Laryngeal Nerves ; Stroke* ; Vocal Cord Paralysis* ; Vocal Cords*

The radiofrequency has been used for percutaneous cordotomy in patient having intractable pain. Recently the use of this radiofrequency has been extended to include other neurosurgical procedures, which in the past were done with chemical agents or mechanical methods etc. We treated one case of trigeminal neuralgia with the radiofrequency. The gasserian ganglion was punctured through the foramen ovale using a modified Hartel technique and the radiofrequency lesion was made in the second and third branches of the right trigeminal nerve selectively. The postoperative result was satisfactory. We reviewed the literature and described the technical procedures and complications.
Cordotomy ; Foramen Ovale ; Humans ; Neurosurgical Procedures ; Pain, Intractable ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*

Effective noninvasive modalities such as radiotherapy and pharmacologic treatments have become highly developed in the treatment of intractable cancer pain. Although epidural narcotics have been considered particularly useful, limitations still remain in their effectiveness for some patients. Surgical therapy can be a useful alternative to these treatments. Cordotomy is one of the most effective surgical treatments. The first percutaneous cordotomy was attempted by Mullan and his associates in 1963. Rosomoff and his associates modified the procedure using radiofrequency two years later. Cordotomy was widely used by the late 1960's but due to its limited effectiveness and serious complications it was abandoned until 1980 when a new electrode was developed by Levin. A thermocouple cordotomy electrode such as the Levin electrode allows monitoring of impedance and tissue temperature. A radiofrequency lesion can be made by increasing the current directly to the desired temperature rather than by gradual heating with the usual incremental increases in lesion current and time. With the use of this electrode, consistent clinical effects are assured and operating time is reduced. The chances of boiling or charring are also minimized. Since this electrode was developed, cordotomy has received renewed attention virtually everywhere except in Korea. Five terminal cancer patients in whom conservative treatments had failed were treated by cordotomy using the three types of thermocouple electrodes: the levin cordotomy electrode; the TCE thermocouple electrode, and the Kanpolat CT electrode. Due to the small number of patients, a comparison of the effectiveness of these three types could not be made. Although complete pain relief was not achieved in every case, dosages of narcotics could be reduced as a result of this procedure. There were no serious complications except a transient paralysis of the ipsilateral arm in one case and headaches in four cases.
Arm ; Cordotomy* ; Electric Impedance ; Electrodes* ; Headache ; Heating ; Hot Temperature ; Humans ; Korea ; Narcotics ; Paralysis ; Radiotherapy ; Trout

Injuries of the larynx are common in patients with a history of inhalation burns. When anesthesia is performed in such patients, the possibility of tracheal intubation should be thoroughly checked in advance, and preparation should be made in case of possible failure. 73-year-old woman who underwent laser cordotomy due to posterior glottic stenosis due to inhalation burn. Her height and weight were 140 cm and 58.9 kg. We proceeded anesthesia, because preoperative fiberoptic laryngoscopy and otolaryngology consultation showed that tracheal intubation was possible. However, the intubation failed and the manual ventilation was not performed afterwards, so the cricothyroidotomy was performed as an emergency. Anesthesia in patients with posterior glottic stenosis due to inhalation burns requires a great deal of attention and, above all, thorough evaluation in order to confirm the possibility of tracheal intubation. If this is not possible, you should look for alternatives and be prepared, and even if you think it's possible, try anesthesia with thorough preparation for the possible failure.
Aged ; Anesthesia ; Burns, Inhalation ; Constriction, Pathologic ; Cordotomy ; Emergencies ; Female ; Humans ; Inhalation ; Intubation ; Laryngoscopy ; Larynx ; Otolaryngology ; Ventilation