In medical practice, each time span has a dogma of that period. Now, in the science
and technology age, one particular dogma is very extensively accepted and used in
pain practice. There is a general belief in neurosurgical practice that lesioning
of the pain conducting system is accepted as ablative and dangerous. This idea is
a dogma and it is wrong. In modern times, modern stereotactic pain surgery is performed
in three important steps. First, morphology and localization of the pain conducting
pathways are demonstrated with special imaging techniques; the surgeon approaches
the target percutaneously by a specially designed needle electrode system. Second,
the function of the target and surrounding structures can be defined by stimulation
just after the target is totally, partially, or selectively destroyed by radiofrequency
lesion. Third, lesioning of the system is controlled at every step of the procedure.
These procedures are applied with morphological real-time demonstration, physiological
evaluation of the target, and, finally, controlled lesioning. In this way, this surgery
is performed safely and effectively. In this paper, I describe the techniques of this
method based on a 17-year experience with three different stereotactic destructive
procedures: CT-guided percutaneous cordotomy, trigeminal tractotomy, and extralemniscal
myelotomy.
KEYWORDS
Intractable pain - minimally invasive - selective - destructive - pain procedures
- CT-guidance
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Yucel KanpolatM.D.
Inkilap Sokak 24/2
Kizilay 06640, Ankara, Turkey
Email: kanpolat@ada.net.tr
