経皮的コルドトミーのための新しい装置と定位的コルドトミー法

A New Apparatus and Stereotactic Method for Percutaneous High Cervical Cordotomy

I．はじめに

　頑痛に対してどの除痛法を選択するかは，患者の痛みの性質，程度，全身状態などにより決定される，除痛法は薬物療法，硬膜外ブロックを含めた各種の末梢神経ブロック，脊髄刺激（spinal cord stimulation）^7,8），手術療法に大別できる．

　これらの除痛法のなかで，特に癌末期のり疼痛に対する除痛法として経皮的コルドトミー（percutaneous highcervical cordotomy）は極めて有効な除痛術のひとつである^{1,2,4-6,9-12）}．

The authors devised a stereotactic apparatus for percutaneous cordotomy based on the experience of 191 percutaneous high cervical cordotomies on 150 patients suffering from intractable pain.

This apparatus has two major components. One is a head and neck holder and the other is a guide and marker system. The head and neck holder contains fixed neck holder and head holder which can be movable in vertical direction. Using these holders, the operator can keep the patient's neck in neutral position. The marker system contains two markers of origin and a 10mm scale which indicates center line as well.