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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(03): e238-e244
DOI: 10.1055/s-0038-1623514
Review Article | Artigo de Revisão

Surgical Treatment for Spasticity: Selective Dorsal Rhizotomy – Technique and Literature Review

Tratamento cirúrgico para espasticidade: Rizotomia dorsal seletiva – Técnica e revisão da literatura
Marcos Paulo dos Santos Teixeira
1   Foundation of Beneficence, Hospital de Cirurgia, Aracaju, SE, Brazil
,
Bernardo Assumpção de Monaco
2   Department of Neurosurgery, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
,
Jessie Medeiros de Navarro
3   Department of Neurophysiology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
,
Emmanuel Alejandro Vazquez
4   Department of Neurosurgery, Hospital Aleman de Bueno Aires, Argentina; Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Arthur José Maia Lopes
5   Neurosurgery Residency, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Thais Cristina de Souza Melo
6   Medical School Graduation, Universidade Federal de Sergipe Aracaju, SE, Brazil
,
Manoel Jacobsen Teixeira
7   Neurosurgery Discipline, Hospital das Clínicas, Faculty of Medicine University of São Paulo, São Paulo, SP, Brazil
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Abstract

Spasticity is a motor disorder that leads to a resistance to passive joint movement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There are many scales that help to measure and monitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safe technique, possible to be performed in most centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.

Resumo

A espasticidade é um distúrbio motor que leva a um quadro de resistência ao movimento articular passivo. A paralisia cerebral é a mais importante causa de espasticidade e pode ser causada por diversos fatores, tais como gestações múltiplas, alcoolismo, infecções, hemorragias, afogamento, lesões cerebrais traumáticas, entre outros. Existem muitas escalas que ajudam a mensurar e acompanhar o grau de acometimento desses pacientes. O tratamento inicial deve focar no fator causal, como tumores, inflamação, doenças degenerativas, hidrocefalia etc. Posteriormente, o tratamento da musculatura espástica inclui miorrelaxantes orais, intratecais, eletroestimulação medular, neurotomias, lesão do trato de Lissauer, dentatotomia e a rizotomia dorsal seletiva. Esta última é uma técnica segura, possível de ser realizada na maioria dos centros com suporte neurocirúrgico, e eficaz no tratamento da espasticidade grave. No presente, artigo, os autores descrevem a técnica cirúrgica e fazem uma revisão da literatura.

Keywords

spasticity - rhizotomy - cerebral palsy - electrical stimulation - surgery

Palavras-chave

espasticidade - rizotomia - paralisia cerebral - monitorização intraoperatória - cirurgia


Publication History

Received: 27 October 2017

Accepted: 04 December 2017

Article published online:
10 May 2018

© 2018. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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