Successful Treatment of Causalgia of Upper Extremity with Medullary Spinothalamic Tractotomy

Analgesic levels and technical method in stereotactic pontine spinothalamic tractotomy

Stereotactic pontine spinothalamic tractotomy was performed on eight patients with severe pain due to malignancy. The procedure enables high levels of analgesia to be obtained with less risk of respiratory and micturition disorders than percutaneous or open cordotomy.

Neurosurgical treatment of chronic pain

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Causalgic pain relieved by prolonged procaine amide sympathetic blockade. Case report

Reversible sympathetic blocks diagnostically relieve causalgic pain. At times, repeated blocks may be therapeutic. Causalgic pain of the left hand was successfully treated in a nonsurgical candidate by a continuous infusion of local anesthetic (procaine) into the region of the stellate ganglion. This technique was performed without significant complication and gave relief from the causalgia for extended periods of time. It may provide an effective alternative to surgical sympathectomy in high-risk patients.

Neurosurgical control of pain in the patient with cancer

If properly evaluated, the majority of patients with intractable pain caused by visceral as well as somatic malignancy can obtain relief. Analgesics are of great value in some cases. They are especially indicated for patients who have conditions producing pain of short duration or for terminal patients. Radiotherapy may temporarily help most patients with intractable pain. Open or stereotactic surgical intervention and especially interruption of the ascending pain fibers within the spinal cord may give permanent relief to patients who have increasingly severe pain. At present the best results are obtained with percutaneous high cervical electrocoagulation of the spinothalamic tracts. Experience with electrical inhibition of pain based on the gate theory is limited. In the future, however, it may replace the present destructive approaches.

Stereotaxic pontine spinothalamic tractotomy

✓ A stereotaxic method of radiocoagulation of the spinothalamic tract at the pontine level is described. A system of coordinates is presented for the spinothalamic tract in relation to the floor of the fourth ventricle. The advantages of tractotomy at this level are discussed, and the results presented in a small series of patients suffering intractable pain. In two cases the lesion has been verified histologically.