Applied neurophysiology
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Indications, technical procedures, and complications are discussed for the performance of thermal electrocoagulation of the trigeminal preganglionic rootlets and gasserian ganglion. Specific steps in preoperative evaluation, premedication, anesthetic management, and technical performance of graded lesion-making utilizing radiographic control, physiologic stimulation and intraoperative patient monitoring are discussed. A survey of complications is presented.
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Percutaneous cervical cordotomy provides a nonoperative opportunity to interrupt the lateral spinothalamic pathways in patients with pain who are not good operative risks for an open cordotomy. The technique is relatively simple, but requires some practice. Indications should be the same as for open cordotomy, with critical patient selection. Results are comparable to those of surgical cordotomy.