Neurochirurgie
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Intractable pain in 4 patients having disseminated cancer was treated by intraventricular morphine. For all these patients, previous efficiency of opiates therapy was assessed by a positive trial of epidural injections of morphine. The latter method had to be stopped and a switch to intraventricular morphine was motivated, in 3 cases, by a local non-tolérance to the subarachnoid catheter. ⋯ Trial times were respectively of 8 days, one month, two months and six months (this latter case still under trial). In comparison with the epidural and lumbar intrathecal administration of morphine, the authors insisted upon the quality of analgesia obtained, the absence of respiratory depression, the comfort and minimal daily quantities of morphine injected (inferior to one mg daily in three cases). Enlightened by these 4 cases, the authors also discussed the relative importance of the spinal and brain mechanisms involved in morphinic analgesia.
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Voltage and current within Gasserian ganglion have been measured during a therapeutical high frequency coagulation of the Gasserian ganglion in 25 consecutive cases. From these values, the impedance (Ohm), the work (Watt) and the total energy (Joule) necessary to obtain an analgesia without anesthesia have been calculated. The study has shown that the temperature and the time of coagulation in correlation with the length of the non isolated tip of the electrode are actually the only constancy in the control of the therapeutical lesions.