Spinothalamic Tractotomy in the Medulla Oblongata

Percutaneous Cordotomy, Tractotomy, and Midline Myelotomy: Minimally Invasive Stereotactic Pain Procedures

“…33,34 White and Sweet also reported the diameter of the spinal cord as 12 AE 1 mm at the equator. 29 In our series, the spinal cord diameters at the C1-C2 level measured 7.0 to 11.4 mm (average 8.66 mm) anteroposteriorly and 9 to 14 mm (average 10.96 mm) transversely. 35 As every patient's spinal cord diameters are unique, the inserted part of the active electrode must be adjusted according to the diametral measurements for each case.…”

“…These patients have usually undergone RF rhizotomy on one side and may have moderate or severe hypoesthesia on that side. 29 A contralateral RF rhizotomy may cause severe difficulties in mastication, and CT-guided TR-NC, which preserves sensory modalities other than pain, may be performed on that side.…”

“…4 Sweet (1942) observed hypoalgesia in the regions innervated by cranial nerves VII, IX, and X after trigeminal tractotomy. 29 Broadal reported ipsilateral analgesia involving the face, mouth, concha of the auricle, posterior part of the tongue, tonsil, and pharynx in four patients after tractotomy performed by Torkildsen in 1947. 50 Kunc developed a high cervical approach technique, and he too used the procedure selectively to relieve glossopharyngeal neuralgia.…”

“…25 In 1962, Brihaye et al tried to confirm the value of such limited transsection and stated that they were able, only once, to obtain analgesia of the upper extremity while sparing the leg. 28 Brihaye et al 28 and White and Sweet 29 concluded that this type of operation, due to the incomplete destruction of the pain-conducting pathway, carries a high risk of pain recurrence. In 1965, Mullan indicated that selective lesions could be made using the percutaneous technique: ''As experience has been gained we have achieved greater precision in obtaining selective cordotomies of arm, leg and trunk.''…”

Painful phantom limb treated by high cervical chordotomy report of two cases

“…Our two cases show that, provided due technical precautions are taken, similarly beneficial results can be achieved by high cervical chordotomy for painful phantoms in the upper limb as have already been achieved by high thoracic chordotomy for painful phantoms in the lower limb. The past failures of high cervical chordotomy are responsible for the suggestion (White, 1944) that division of the spinothalamic tract within the medulla (Schwanz andO'Leary, 1941 and1942 j White, 1941) or even higher still in the midbrain (Walker, 1942) would prove after a trial to be preferable procedures. However, in none of the published reports of these operations does a sufficiently high, and yet complete, level of analgesia appear to have been obtained.…”