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SPINOTHALAMIC TRACTOTOMY IN THE MEDULLA OBLONGATA: AN OPERATION FOR THE RELIEF OF INTRACTABLE NEURALGIAS OF THE OCCIPUT, NECK AND SHOULDER

SPINOTHALAMIC TRACTOTOMY IN THE MEDULLA OBLONGATA: AN OPERATION FOR THE RELIEF OF INTRACTABLE... Abstract Not infrequently the neurosurgeon is confronted by a case of intractable pain distributed so high over the shoulder and neck that it cannot be interrupted by cordotomy, no matter how high the spinothalamic tract is sectioned in the cervical portion of the spine. Pain of this type is most often due to neuralgia arising in an amputation stump of the upper part of the arm or shoulder or caused by avulsion or carcinomatous infiltration of the brachial plexus or to one of the rare unexplained neuralgias which may follow an operative incision or a penetrating wound of the neck or upper part of the back. As is well known, such conditions have been most difficult to relieve, even with extensive resection of the posterior cervical sensory roots and the consequent sacrifice of a useful arm. It has been observed clinically in patients with thrombosis of the posterior inferior cerebellar artery References 1. Wechsler, I. S.: A Text-Book of Clinical Neurology , ed. 2, Philadelphia, W. B. Saunders Company, 1933, p. 368. 2. Walker, A. E.: The Spinothalamic Tract in Man , Arch. Neurol. & Psychiat. 43:284-298 ( (Feb.) ) 1940. 3. Dogliotti, M.: First Surgical Sections, in Man, of the Lemniscus Lateralis (Pain-Temperature Path) at the Brain Stem, for the Treatment of Diffused Rebellious Pain , Anesth. & Analg. 17:143-145, 1938. 4. Sjöqvist, O.: Studies on Pain Conduction in the Trigeminal Nerve: A Contribution to the Surgical Treatment of Facial Pain , Acta psychiat. et neurol. , 1938, (supp. 17) , pp. 1-139. 5. Schwartz, H. G., and O'Leary, J. L.: Section of the Spinothalamic Tract in the Medulla with Observations on the Pathway for Pain , Surgery 9:183-193, 1941. 6. Smithwick, R. H.: Surgical Intervention on the Sympathetic Nervous System for Peripheral Vascular Disease , Arch. Surg. 40:286-306 ( (Feb.) ) 1940. 7. The circulatory aspects of the case of J. S. have been summarized by Smithwick.6 8. Neuralgia following this operation has never been observed in any other patient. 9. Rowbotham, G. F.: Treatment of Pain in the Face by Intramedullary Tractotomy , Brit. M. J. 2:1073-1076, 1938. 10. Grant, F. C., and Weinberger, L. M.: Experiences with Intramedullary Tractotomy: I. Relief of Facial Pain and Summary of Operative Results , Arch. Surg. 42:681-692 ( (April) ) 1941. 11. List, C. G., and Peet, M. M.: Sweat Secretion in Man: V. Disturbances of Sweat Secretion with Lesions of the Pons, Medulla and Cervical Portion of Cord , Arch. Neurol. & Psychiat. 42:1098-1127 ( (Dec.) ) 1939. 12. Foerster, O.: Die vegetativen supranuclearen Bahnen und die Reflexe der vegetativen Sphäre , in Bumke, O., and Foerster, O.: Handbuch der Neurologie , Berlin, Julius Springer, 1936, vol. 5, p. 213. 13. Magoun, H. W.: Descending Connections from the Hypothalamus , A. Research Nerv. & Ment. Dis., Proc. (1939) 20:270-285, 1940. 14. Foerster, O.: Die Leitungsbahnen des Schmerzgefühls und die chirurgische Behandlung der Schmerzzustände , Berlin, Urban & Schwarzenberg, 1927. 15. Hyndman, O. R., and Van Epps, C.: Possibility of Differential Section of the Spinothalamic Tract , Arch. Surg. 38:1036-1053 ( (June) ) 1939. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

SPINOTHALAMIC TRACTOTOMY IN THE MEDULLA OBLONGATA: AN OPERATION FOR THE RELIEF OF INTRACTABLE NEURALGIAS OF THE OCCIPUT, NECK AND SHOULDER

Archives of Surgery , Volume 43 (1) – Jul 1, 1941

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Publisher
American Medical Association
Copyright
Copyright © 1941 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1941.01210130116010
Publisher site
See Article on Publisher Site

Abstract

Abstract Not infrequently the neurosurgeon is confronted by a case of intractable pain distributed so high over the shoulder and neck that it cannot be interrupted by cordotomy, no matter how high the spinothalamic tract is sectioned in the cervical portion of the spine. Pain of this type is most often due to neuralgia arising in an amputation stump of the upper part of the arm or shoulder or caused by avulsion or carcinomatous infiltration of the brachial plexus or to one of the rare unexplained neuralgias which may follow an operative incision or a penetrating wound of the neck or upper part of the back. As is well known, such conditions have been most difficult to relieve, even with extensive resection of the posterior cervical sensory roots and the consequent sacrifice of a useful arm. It has been observed clinically in patients with thrombosis of the posterior inferior cerebellar artery References 1. Wechsler, I. S.: A Text-Book of Clinical Neurology , ed. 2, Philadelphia, W. B. Saunders Company, 1933, p. 368. 2. Walker, A. E.: The Spinothalamic Tract in Man , Arch. Neurol. & Psychiat. 43:284-298 ( (Feb.) ) 1940. 3. Dogliotti, M.: First Surgical Sections, in Man, of the Lemniscus Lateralis (Pain-Temperature Path) at the Brain Stem, for the Treatment of Diffused Rebellious Pain , Anesth. & Analg. 17:143-145, 1938. 4. Sjöqvist, O.: Studies on Pain Conduction in the Trigeminal Nerve: A Contribution to the Surgical Treatment of Facial Pain , Acta psychiat. et neurol. , 1938, (supp. 17) , pp. 1-139. 5. Schwartz, H. G., and O'Leary, J. L.: Section of the Spinothalamic Tract in the Medulla with Observations on the Pathway for Pain , Surgery 9:183-193, 1941. 6. Smithwick, R. H.: Surgical Intervention on the Sympathetic Nervous System for Peripheral Vascular Disease , Arch. Surg. 40:286-306 ( (Feb.) ) 1940. 7. The circulatory aspects of the case of J. S. have been summarized by Smithwick.6 8. Neuralgia following this operation has never been observed in any other patient. 9. Rowbotham, G. F.: Treatment of Pain in the Face by Intramedullary Tractotomy , Brit. M. J. 2:1073-1076, 1938. 10. Grant, F. C., and Weinberger, L. M.: Experiences with Intramedullary Tractotomy: I. Relief of Facial Pain and Summary of Operative Results , Arch. Surg. 42:681-692 ( (April) ) 1941. 11. List, C. G., and Peet, M. M.: Sweat Secretion in Man: V. Disturbances of Sweat Secretion with Lesions of the Pons, Medulla and Cervical Portion of Cord , Arch. Neurol. & Psychiat. 42:1098-1127 ( (Dec.) ) 1939. 12. Foerster, O.: Die vegetativen supranuclearen Bahnen und die Reflexe der vegetativen Sphäre , in Bumke, O., and Foerster, O.: Handbuch der Neurologie , Berlin, Julius Springer, 1936, vol. 5, p. 213. 13. Magoun, H. W.: Descending Connections from the Hypothalamus , A. Research Nerv. & Ment. Dis., Proc. (1939) 20:270-285, 1940. 14. Foerster, O.: Die Leitungsbahnen des Schmerzgefühls und die chirurgische Behandlung der Schmerzzustände , Berlin, Urban & Schwarzenberg, 1927. 15. Hyndman, O. R., and Van Epps, C.: Possibility of Differential Section of the Spinothalamic Tract , Arch. Surg. 38:1036-1053 ( (June) ) 1939.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1941

References