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Topic: Cordotomy

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	AANS.org \| Education and Meetings \| AANS Scientific Journals \| Neurosurgical Focus
		Cordotomy is an effective procedure for relieving intractable pain and has been used to treat patients with unilateral pain of the lower body and lower extremities.
		Computerized tomography--guided percutaneous bilateral selective cordotomy may prove to be the treatment of choice for patients suffering from bilateral cancer pain, because of the advantages of higher segmental selectivity and controlled ablation of neural structures at a higher cervical level under direct visualization.
		The target in percutaneous cordotomy is the lateral spinothalamic tract in the anterolateral part of the spinal cord at the C1--2 level, although the posterolateral part of the lateral spinothalamic tract should be targeted to control pain from the lower trunk and extremities, as is done in bilateral procedures.
	www.aans.org /education/journal/neurosurgical/jan97/2-1-4.asp (2884 words)

	Hospice World (via CobWeb/3.1 planetlab2.tamu.edu) (Site not responding. Last check: 2007-10-26)
		A cordotomy involves destruction of pain fibers in the anterolateral quadrant of the spinal cord (where the sensory fibers run in the spino-thalamic tract) resulting in contralateral analgesia (pain fibers cross to the opposite side of the cord).
		Cordotomy is performed contralateral to the tumor and the pain.
		Bilateral cordotomy is avoided because of the danger of Ondine’s syndrome (loss of the involuntary breathing reflex and, therefore, resultant inability to sleep).
	www.hospiceworld.org.cob-web.org:8888 /book/cordotomy.htm (423 words)

	Computerized tomography -- guided percutaneous bilateral selective cordotomy
		Computerized tomographyguided percutaneous bilateral selective cordotomy may prove to be the treatment of choice for patients suffering from bilateral cancer pain, because of the advantages of higher segmental selectivity and controlled ablation of neural structures at a higher cervical level under direct visualization.
		The target in percutaneous cordotomy is the lateral spinothalamic tract in the anterolateral part of the spinal cord at the C12 level, although the posterolateral part of the lateral spinothalamic tract should be targeted to control pain from the lower trunk and extremities, as is done in bilateral procedures.
		An anterior approach to percutaneous transdiscal lower cervical cordotomy at the C45 and C56 levels was described by Lin, et al.,[26] as advantageous over the high cervical technique to avoid the possible complication of a disturbing involuntary respiration.
	www.c3.hu /~mavideg/jns/2-1-4.html (2902 words)

	Anterolateral Cordotomy (Spinal Tractotomy) (Site not responding. Last check: 2007-10-26)
		Anterolateral cordotomy is an ablative procedure aimed at the pain-conducting tracts in the anterolateral quadrant of the spinal cord.
		Cordotomy provides the selective loss of pain and temperature perception several segments below and contralateral to the segment at which the lesion is placed.
		Open cordotomy may benefit patients in whom a percutaneous procedure has failed, those who cannot cooperate because of severe pain or confusion, those at risk for respiratory compromise, or those with bilateral pain in whom a bilateral, high cervical cordotomy carries additional risk of necrologic impairment.
	www.painresearch.utah.edu /cancerpain/LS5.4.1.3.html (223 words)

	Medscape MEDLINE search: Cordotomy
		The question whether the spinothalamic and spinoreticular fibres cross the cord transversely or diagonally was investigated in cases of anterolateral cordotomy and in a case of thrombosis of the anterior spinal artery.
		The spinothalamic tract (STT) is a major ascending nociceptive pathway, interruption of which by cordotomy is used for pain relief, whereas the dorsal column (DC) pathway is usually not considered to be involved in pain transmission.
		OBJECTIVES: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP).
	search.medscape.com /uslclient/searchMedline.do?queryText=Cordotomy (924 words)

	voice problems
		This procedure, known as laser cordotomy, can significantly improve your ability to breathe while maintaining vocal quality, and is available at only a handful of medical centers nationwide.
		General anesthesia is used during the procedure and antibiotics and steroids are prescribed during the three-month healing process.
		Although laser cordotomy may not be the answer for everyone with vocal cord paralysis, it offers benefits for many people.
	cms.clevelandclinic.org /headandneck/body.cfm?id=160 (707 words)

	Guideline 44 Section 12: Interventional techniques for the treatment of pain from cancer
		Bilateral cordotomy can be performed, but although this will stop pain on both sides of the body it does not affect midline pain and is generally associated with a higher incidence of side effects.
		Cordotomy may be performed as an open operation, or as a percutaneous procedure.
		Special care is needed in patients with impaired lung function, as percutaneous cervical cordotomy may cause some reduction in the expansion of the lung on the side of the procedure.
	www.sign.ac.uk /guidelines/fulltext/44/section12.html (1660 words)

	Article Figures and Tables
		Motor function was evaluated by assessing the reduction in grip strength in the hand ipsilateral to the site of cordotomy compared with that measured during the preoperative period.
		Bar graph showing the difference in the effect of cordotomy on pain sensation in some region and in the painful region between patients with and without new pain.
		The effect of cordotomy was analyzed in patients with and without new pain.
	www.thejns-net.org /jns/issues/v95n3/fig_tab/n0950425_t3.html (301 words)

	Anaesthesia UK : Neurosurgical techniques in the treatment of chronic pain
		Open cordotomy is usually undertaken under general anaesthesia, although techniques of waking the patient during the procedure to confirm satisfactory lesioning of the cord have been described.
		Improvements in the drug treatment of pain mean that cordotomy is less commonly undertaken, but it remains a useful method of pain control for malignant disease.
		In cervical cordotomy, the reticulospinal fibres responsible for spontaneous respiration are also destroyed, and if carried out bilaterally there is a risk of respiratory failure.
	www.anaesthesiauk.com /article.aspx?articleid=100542 (1637 words)

	ThirdAge: Treatment of chronic pain
		The most common is cordotomy: severing the nerve fibers on one or both sides of the spinal cord that travel the express routes to the brain.
		Cordotomy affects the sense of temperature as well as pain, since the fibers travel together in the express route.
		Besides cordotomy, surgery within the brain or spinal cord to relieve pain includes severing connections at major junctions in pain pathways.
	www.thirdage.com /healthgate/files/21197.html (2169 words)

	AANS.org \| Library
		Methods: Computerized tomography::guided cordotomy was performed in four patients with pain related to tumor invasion to the brachial plexus.
		Results: After cordotomy, patients had immediate relief of pain and maintained pain relief, until death 4 to 14 months later.
		Conclusion: Computerized tomography::guided cordotomy is an effective treatment of neuropathic pain caused by brachial plexus invasion by tumor.
	www.aans.org /Library/Article.aspx?ArticleId=19515 (185 words)

	Effects of age at cordotomy and subsequent exercise on contraction times of motor units in the cat. (Site not responding. Last check: 2007-10-26)
		Effects of age at cordotomy and subsequent exercise on contraction times of motor units in the cat.
		The MUs were tested approximately 12 wk after the low-thoracic cordotomy, and comparisons were made with data from control animals.
		The CT of 50.9 ms obtained for SOL units (n = 163) in the spinal cats was 22% shorter than the mean of 65.0 ms for MUs (n = 57) from control cats (n = 4).
	www.arclab.org /medlineupdates/abstract_8125890.html (238 words)

	Position of Spinothalamic Tract Axons in Upper Cervical Spinal Cord of Monkeys -- Zhang et al. 84 (3): 1180 -- Journal ...
		The primate spinothalamic tract as demonstrated by anterolateral cordotomy and commissural myelotomy.
		Percutaneous cervical cordotomy: a review of 181 operations on 146 patients with a study on the location of "pain fibers" in the C-2 spinal cord segment of 29 cases.
		Sanders M, and Zurmond W. Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients.
	jn.physiology.org /cgi/content/full/84/3/1180 (3850 words)

	eMedicine - Arytenoid Fixation : Article by Robert A Buckmire, MD (Site not responding. Last check: 2007-10-26)
		The transverse laser cordotomy, which Kashima (1991) popularized, is designed to enlarge the posterior glottic airway while maintaining close opposition of the anterior true vocal folds for phonation.
		In CA fixation, the magnitude of posterior glottic enlargement with cordotomy is entirely independent of arytenoid position and mobility, unlike with the techniques designed to achieve vocal-fold lateralization.
		A comparison of postsurgical airway and phonatory outcomes for transverse cordotomy and medial arytenoidectomy to treat bilateral vocal-fold immobility demonstrated that the procedures yielded satisfactory and fairly comparable outcomes.
	www.emedicine.com /ent/topic609.htm (3014 words)

	eMedicine - Vocal Fold Paralysis, Bilateral : Article by Joel A Ernster, MD (Site not responding. Last check: 2007-10-26)
		Four techniques are discussed in further detail: posterior cordotomy or cordectomy, endoscopic limited or complete arytenoidectomy, suture lateralization (Ejnell procedure), and laryngofissure with arytenoidectomy.
		Specific complications of posterior cordotomy and endoscopic partial or complete arytenoidectomy include granuloma formation, chondritis of arytenoids, carbon dioxide laser–related fire, IA scar formation, possible aspiration, and a breathy voice.
		Posterior cordotomy or submucous resection of the vocal fold precedes suturing.
	www.emedicine.com /ent/topic348.htm (5643 words)

	Myelomenigocele Kyphectomy: Review of the Effects of Cordotomy on Urodynamics
		The purpose of this study is to review the urologic sequelae of cordotomy in the performance of kyphectomy in patients with myelomeningocele.
		Bladder function was assessed clinically and quantitatively with urodynamics pre- and post-operatively in 12 children who underwent this procedure at our institution between 1992 and 2000.
		We conclude that cordotomy can be performed in the correction of myelomeningocele kyphosis without adverse urologic sequelae.
	www.spineuniverse.com /print.php/article229.html (255 words)

	Congenital kyphosis in myelomeningocele: THE EFFECT OF CORDOTOMY ON BLADDER FUNCTION -- Lalonde and Jarvis 81-B (2): ...
		Congenital kyphosis in myelomeningocele: THE EFFECT OF CORDOTOMY ON BLADDER FUNCTION -- Lalonde and Jarvis 81-B (2): 245 -- Journal of Bone and Joint Surgery - British Volume
		To determine the effect of cordotomy on the function of the
		Cordotomy, at or below the level of the kyphosis, allows excellent
	www.jbjs.org.uk /cgi/content/abstract/81-B/2/245 (264 words)

	Current and Emerging Issues in Cancer Pain: Research and Practice
		Few members of the audience referred patients for cordotomy, either percutaneous or by open neurosurgical approach.
		It was suggested that cordotomy could be of value in unilateral pain, but not at the high cervical level.
		Epidural and intrathecal blocks with local anesthetic were used by some members of the audience when pain was difficult to control with conventional drug measures.
	www.painresearch.utah.edu /cancerpain/ch25.html (1257 words)

	NeurosurgeryToday.org \| What is Neurosurgery \| Neurosurgical Procedural Statistics Report \| glossary of terms
		Cerebrovascular - Of or involving the blood vessels in or supplying the nervous system.
		Cordotomy - Surgical division of a tract of the spinal cord for relief of severe intractable pain.
		Corpectomy - A surgical procedure performed in the front of the neck that involves removal of a part of the vertebral body to relieve pressure in the spinal cord and nerve roots.
	www.neurosurgerytoday.org /what/stats/glossary.asp (564 words)

	[No title] (Site not responding. Last check: 2007-10-26)
		In conclusion, both procedures are very valuable to control thoracic pain due to locally advanced cancer, but cordotomy is superior to subarachnoid phenol, as it has a better outcome particularly for long-term pain management.
		The patient’s position was maintained for 30 minutes, with kidney rests or with wide adhesive tape across the patient’s body attached to the lateral edges of the table.
		Group II (cordotomy group): CT-guided percutaneous radiofrequency RF high cervical cordotomy where destruction of the contralateral spinothalamic tract at the C1-C2 level was the target of management in this group.
	www.janssen-cilag.com.eg /journal/April01-6.doc (1621 words)

	ALA: PEDIATRIC BILATERAL VOCAL CORD IMMOBILITY: THE ROLE OF THE CARBON DIOXIDE LASER POSTERIOR TRANSVERSE PARTIAL ...
		This report describes an adaptation of the CO2 laser partial transverse cordotomy used in adults and introduced by Kashima.
		The C02 laser partial cordotomy was successful in all 4 patients.
		These results can be achieved during a short operative procedure that has been practical, well tolerated, and successful.
	www.alahns.org /trans/trans99/friedman.php (202 words)

	Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients -- Sanders and ... (Site not responding. Last check: 2007-10-26)
		Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients -- Sanders and Zuurmond 13 (6): 1509 -- Journal of Clinical Oncology
		Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients
		and bilateral percutaneous cervical cordotomy (BPCC) was studied in 62 and
	www.jco.org /cgi/content/abstract/13/6/1509 (373 words)

	Pain Management: Narcotics through Surgery
		Although the operation can cause the spine to stiffen, resulting in lost flexibility, the procedure serves one critical purpose: protection of the spinal cord.
		Other operations for pain include rhizotomy, in which a nerve close to the spinal cord is cut, and cordotomy, where bundles of nerves within the spinal cord are severed.
		Cordotomy is generally used only for the pain of terminal cancer that does not respond to other therapies.
	www.spineuniverse.com /rtbarticle.php/article2731.html (855 words)

	Pain Medicine & Palliative Care: Pain Medicine
		Surgery to treat pain (rather than the underlying disease) is only appropriate in cases where more conservative approaches have failed and where trained neurosurgeons and follow-up care are available.
		A surgeon can cut a nerve close to the spinal cord (rhizotomy) or bundles of nerves in the spinal cord (cordotomy) to interrupt the pathways that send pain signals to the brain.
		For example, a patient who has a painful neuroma develop after a nerve injury might be cured if the neuroma is removed.
	www.stoppain.org /pain_medicine/content/treatments/surgical.asp (239 words)

	ALA: Laser Cordotomy Versus Radiotherapy: An Objective Cost Analysis
		JAMES H. This study presents a cost analysis of and comparison between laser cordotomy and external beam irradiation for the treatment of early glottic carcinoma.
		It compares the curative results of the two modalities from data of a retrospective study at my institution and a literature review of published cure rates.
		The findings of this study indicate that the cure rates are equivalent and that voice quality obtained after laser cordotomy is comparable to that obtained after irradiation, yet the total cost of external beam radiotherapy is significantly higher than that of laser surgery.
	www.alahns.org /trans/trans00/brandenburg.php (151 words)

	Module 12: Management of Cancer Pain: Other Analgesic Approaches and End-of-Life Care
		Although these techniques are now rarely performed, the most useful has been cordotomy (spinothalamic tractotomy), which is performed percutaneously in the awake patient with unilateral pain below the mid thoracic level.
		Postcordotomy dysesthesia, a neuropathic pain that is often refractory to treatment, can appear many months after cordotomy and is an infrequent but potentially serious complication.
		Other denervating procedures, such as neurectomy or rhizotomy, can be performed in patients with focal pain syndrome isolated to discrete nerves or roots.
	www.ama-cmeonline.com /pain_mgmt/module12/06neur/index.htm (245 words)

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