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Blaine S. Nashold Jr., Amr O. El-Naggar, Janice Ovelmen-Levitt, and Muwaffak Abdul-Hak

the C-2 vertebral level (narrowest part of the caudalis nucleus). Electrode B is used from the C-1 level to the obex (widest part of the caudalis nucleus). The RF lesions are made at 75°C for 15 seconds. Fig. 3. Drawings of the operative site at the cervicomedullary junction illustrating the placement of radiofrequency lesions (line of circles ). XI = the accessory nerve; m = muscle; n = nerve; a = artery. Clinical Results Patient Population A group of 21 patients (15 women and six men) with chronic facial pain were operated on using

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that precise lesions may be made within the DREZ using the radiofrequency needle electrode technique as well as the laser. Certainly, radiofrequency lesions made with excessive currents will produce effects that extend beyond the DREZ. However, this is also true with laser lesions. In order to make meaningful comparisons of the two techniques, one must compare lesions made at a variety of power settings with both tools. We have found significant variability in DREZ lesions made with the CO 2 laser. This variability depends on spinal cord movement with respirations

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Radiofrequency Lesions in the Central Nervous System of Man and Cat:

Including Case Reports of Eight Bulbar Pain-Tract Interruptions

W. H. Sweet, V. H. Mark, and H. Hamlin

to achieve this with anodal direct current in the central nervous system of man and cat was a conspicuous failure. 6 A trial with radiofrequency current to produce such lesions was initiated in a series of experiments on cats. The results of these experiments are reported in the first part of this paper, and, on the basis of these results, a series of lesions were placed in the central nervous system of human patients with intractable pain caused by advanced cancer. Radiofrequency lesions of the same size were made in different patients in the arcuate nucleus of

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Michael Sanders and Wouter W. A. Zuurmond

. Radiofrequency Lesioning Protocol The patient is placed supine on the operating table with the head immobilized by a strip of adhesive bandage. The pterygopalatine fissure is localized during transverse fluoroscopy and a line is drawn using a marker and a metal ruler over the skin in this position ( Fig. 1 ). The intersection of this line with the inferior edge of the zygomatic arch (infrazygomatic approach) is the entry point. Using this entry point, inadvertent puncture of the buccal mucosa is avoided. After subcutaneous injection of 2 ml of 2% lidocaine, a 10-cm-long 22

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Robert J. Stolker, Arnoud C. M. Vervest, and Gerbrand J. Groen

diagnosis of segmental pain; 2) to determine the appropriate level of treatment; and 3) to assess the potential benefit of PPR. However, as stated by other authors, treatment failure after a positive prognostic block is still possible. 20, 26, 36, 45 Such treatment failure may be due to the more localized action of a radiofrequency lesion compared to local anesthetics, 2, 6, 22 technical failures from heat loss via nearby blood vessels, 5 afferent fibers in the ventral root, 4 ectopic ganglion cells, 12 intersegmental nervous connections, 31 sympathetic maintenance

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Jae Y. Lim, Antonio A. F. de Salles, Jeff Bronstein, Donna L. Masterman, and Jeffrey L. Saver

-Levitt J : Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery 15 : 945 – 950 , 1984 Cosman ER, Nashold BS, Ovelman-Levitt J: Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery 15: 945–950, 1984 8. De Salles AAF , Brekhus SD , De Souza EC , et al : Early postoperative appearance of radiofrequency lesions on magnetic resonance imaging. Neurosurgery 36 : 932 – 937 , 1995 De Salles AAF, Brekhus SD, De Souza EC, et al: Early

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Andrew G. Parrent

, stereotactic ablation of the hypothalamic hamartoma was performed. After regional anesthesia had been induced and a Leksell stereotactic frame had been placed, the patient underwent volumetric T 1 -weighted MR imaging of the brain. The MR images were reconstructed as thin contiguous axial and coronal slices, and radiofrequency lesions were planned to encompass the entire volume of the hamartoma ( Fig. 1 left ). Fig. 1. Coronal T 1 -weighted MR images. Left: Image revealing the cavity from the previous right temporal lobectomy and the hypothalamic hamartoma in the region

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David J. Skirving and Noel G. Dan

statistical analysis is not feasible. A review of the literature reveals that the results of PBC 1, 3, 5, 9, 12–15, 17, 23 match those of radiofrequency lesioning 2, 4, 8, 11, 12, 18, 21, 24, 26, 28 and glycerol rhizolysis, 7, 10, 12, 16, 25, 29 often with fewer adverse effects. Our approach has been to offer the entire range of options, with the preference given to the simplest technique. Our study of PBC confirms the favorable outcomes reported in previously published studies, justifying the increasing popularity of the procedure. We have not compared the

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Oleg Kopyov, Deane Jacques, Christopher Duma, Galen Buckwalter, Alex Kopyov, Abraham Lieberman, and Brian Copcutt

than the GP was used as the center of the stereotactic arc to ensure that the internal capsule was excluded from the probe track; and 4) the length of the needle track was minimized by creating the most direct route possible from the cortex to the target. The 29 patients with recalcitrant Parkinson's disease discussed in this study received radiofrequency lesions placed in the medial aspect of the posteroventral pallidum (posteroventral medial pallidotomy) during the course of 1 year. Targeting for the procedure was guided by MR imaging and used microelectrode

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Berkley L. Rish

had become refractory to Tegretol therapy. After appropriate evaluation, a percutaneous radiofrequency lesion was undertaken. Operations . The needle was passed to the foramen ovale, the foramen lacerum was entered, and arterial backflow was noted. As has been suggested by others, the needle was simply withdrawn, redirected slightly laterally, and the foramen ovale was entered without further difficulty ( Fig. 1 ). After several manipulations, stimulation indicated a satisfactory second division target and a lesion was made in the fashion described by Nugent and