Spinal cord stereotactic techniques re trigeminal nucleotomy and extralemniscal myelotomy

The application of stereotactic techniques to the spinal cord as a logical sequel to percutaneous procedures have produced significant developments by enabling the functional exploration of different cord structures. Radiofrequency lesions were placed either at the spinal trigeminal nucleus, for facial pain of central origin such as postherpetic neuralgia or anesthesia dolorosa as well as for neoplastic pain of extensive craniofacial distribution, or at the central cord region to interrupt preferentially multisynaptic nonspecific pathways mainly for midline and/or bilateral pain but also for patients with respiratory inadequacy or for certain central pain states. Technical aspects are reported, and physiological correlates relevant to surgery are analyzed. Results, indications and limitations are discussed.