Computerized tomography-guided percutaneous bilateral selective cordotomy.
Percutaneous bilateral cordotomy performed using conventional techniques may cause the patient to develop sleep-induced apnea due to bilateral destruction of the ventrolateral reticulospinal tract. Computerized tomography (CT)-guided percutaneous cordotomy using a newly designed needle electrode system has the advantages of safe, selective, and controlled lesioning under direct visualization in the lateral spinothalamic tract. Given its low complication rate, bilateral selective cordotomy performed with CT guidance using this new needle electrode system may prove to be the treatment of choice for cancer patients with bilateral pain of the lower trunk and extremities. The present series included five cancer patients suffering from intractable pain bilaterally in the lower trunk and extremities. All were treated with CT-guided bilateral selective cordotomy: the results demonstrate that this technique may be used effectively and safely.