Punctate midline myelotomy for the relief of visceral cancer pain.

Abstract:

OBJECT:This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. METHODS:A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. CONCLUSIONS:These findings provide corroborating clinical evidence for the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Nauta HJ,Soukup VM,Fabian RH,Lin JT,Grady JJ,Williams CG,Campbell GA,Westlund KN,Willis WD Jr

doi

10.3171/spi.2000.92.2.0125

subject

Has Abstract

pub_date

2000-04-01 00:00:00

pages

125-30

issue

2 Suppl

eissn

0022-3085

issn

1933-0693

journal_volume

92

pub_type

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