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PubMed1989

CT-guided percutaneous cordotomy.

Percutaneous cordotomy is a commonly applied and effective procedure among the ablative pain surgeries. As plain X-ray does not permit visualization of the target relative to the electrode the chances of obtaining good results are decreased and the risk of complications are increased. The use of CT has been found to be useful in cordotomy. The procedure is performed under CT control on the patients who have previously been given 5 ml iohexol into the subarachnoid space. The needle electrode is manipulated by free hand technique. It is possible to measure the diameter of the spinal cord and to detect cord dislocation in the spinal canal. When the electrode system is introduced it is possible to visualize the tip of the electrode which is pushing or puncturing the spinal cord. As the procedure directly visualizes the relation of the electrode to the target it is possible to place the electrode in the lateral spinothalamic tract. Another advantage of the procedure is to enable us to visualize haematomas or other changes that may result from the cordotomy. The application of the technique and clinical results will be presented.

Electrocoagulation↗
PubMed1981

The lumbar puncture. Patterns of use in clinical practice.

The records of 195 patients who had undergone lumbar puncture (LP) before or after the introduction of computerized axial tomography (CT) were reviewed. Twenty percent of the patients had potentially important spinal fluid abnormalities. The LP changed the diagnosis in 10% of the patients and changed therapy in 10% of the patients. It contributed to the patient's care in 32% of the patients prior to the introduction of the CT and in 48% of the patients after the introduction of the CT (p less than 0.05). Introduction of the CT was associated with a 35% decrease in the frequency of the LP (p less than 0.05). We found that fungal and AFB cultures did not appear to be indicated in most patients. We conclude that use of the LP has improved since the introduction of the CT. Further improvement is still possible, however.

Evaluation Studies as Topic↗
PubMed1994

Effect of needle puncture on morphine and lidocaine flux through the spinal meninges of the monkey in vitro. Implications for combined spinal-epidural anesthesia.

BACKGROUND: Combined spinal-epidural anesthesia is a technique growing in popularity. However, there have been no attempts to investigate the risk of epidural drug reaching the subarachnoid space in high concentration by passing through the meningeal hole left by the spinal needle. This study begins to address this question by quantitating the flux of morphine and lidocaine through the spinal meninges of the monkey in vitro after puncture with three different-sized needles. METHODS: Spinal meningeal tissue from anesthetized monkeys was mounted in a diffusion cell and drug flux was measured through intact tissue and through tissue punctured with a 27-G Whitacre, a 24-G Sprotte, and an 18-G Tuohy needle. RESULTS: The flux of morphine through the meningeal tissue was significantly increased by puncture with each of the study needles. The flux of lidocaine was significantly increased only by puncture with the 24-G Sprotte and 18-G Tuohy needles. The flux of morphine through intact tissue was less than the flux of lidocaine through intact tissue. In contrast, the flux of morphine and lidocaine were the same through tissue punctured with the study needles. The magnitude of the drug flux through the needle puncture was a function of the diameter of the study needle. CONCLUSIONS: Epidural anesthesia after accidental or intentional puncture of the spinal meninges has occasionally resulted in high spinal blocks and total spinal anesthesia. This study suggests that drug movement through the meningeal hole is responsible for this complication and that the risk may be decreased by using the smallest possible needle to puncture the meninges.

Anesthesia, Epidural↗