High cervical commissural myelotomy in the treatment of pain

Papo, I; Luongo, A.

doi:10.1016/0304-3959(77)90111-7

Cited by 9 publications

(10 citation statements)

References 4 publications

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“…These symptoms are reported to generally improve with time and this was seen in our series as well [27,28] . There was also a low incidence (1 patient) of postoperative urinary retention, another complication that has been documented in the literature [24] .…”

Section: Present Seriessupporting

confidence: 58%

Commissural Myelotomy in the Treatment of Intractable Visceral Pain: Technique and Outcomes

Viswanathan

Burton

Rekito

et al. 2010

Stereotact Funct Neurosurg

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Background: Commissural myelotomy can be valuable for patients with intractable pain associated with malignancy in the abdominal or pelvic region. Methods: Between December 1992 and June 2009, 11 patients underwent commissural myelotomy at the University of Texas MD Anderson Cancer Center for the treatment of intractable lower extremity, thoracic, pelvic or sacral pain associated with unresectable tumors. The various surgical approaches to myelotomy are discussed. Results: Eight patients had excellent or good outcomes with regard to pain relief, defined as no further pain (excellent) or a significant reduction in pain and not requiring opioids stronger than codeine (good). Complications included new leg weakness (n = 3) and bladder dysfunction (n = 1). Conclusion: We found that for the properly selected patient, open midline commissural myelotomy can provide effective pain relief with acceptable postoperative morbidity.

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Section: Present Seriessupporting

confidence: 58%

Commissural Myelotomy in the Treatment of Intractable Visceral Pain: Technique and Outcomes

Viswanathan

Burton

Rekito

et al. 2010

Stereotact Funct Neurosurg

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“…Limited midline myelotomies introduced by Hitchcock [11][12][13] were originally designed to sever only the crossing spinothalamic tract fibers at a specific spinal level. Despite the restricted extent of the lesion, the limited midline lesions at C-1 15,17,18 and at T-10 8 were reported to provide surprisingly widespread visceral pain relief while sparing proprioceptive and other sensory perception. Schvarcz 17,18 postulated that the pain relief was due to interruption of a polysynaptic ascending system in the central region of the cord.…”

Section: Discussionmentioning

confidence: 98%

Surgical interruption of a midline dorsal column visceral pain pathway

Nauta

Hewitt²,

Westlund³

et al. 1997

Journal of Neurosurgery

138

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A punctate midline myelotomy performed in a patient effectively eliminated residual, intractable pelvic pain, which remained after resolution of uterine cervical cancer. The authors describe the case history of the patient, in whom pain assessments were made, and a surgical procedure performed. Despite large doses of opiate analgesic medications, the patient experienced constant pressure pain in the right lower pelvis, with excruciating pain on bowel movement. Severe weight loss necessitated better pain control. A minimally invasive surgical procedure, a 5-mm deep puncture using a 16-gauge needle on either side of the median septum in the dorsal column of the spinal cord (T-8), resulted in no new neurological deficits. Narcotic medication was tapered, no pain was reported, and the patient resumed daily household activity. Midline myelotomy has typically been performed with the intention of eliminating the crossing fibers of the spinothalamic tract in the anterior white matter commissure. The punctate midline myelotomy described here was performed with the specific intention of interrupting a newly described visceral pain pathway that ascends to higher brain centers through the midline of the dorsal column. The effectiveness of the pain relief seen in this patient suggests that visceral pain of the pelvis in humans may be transmitted in the midline of the dorsal column, as has been recently reported in studies using rats. The effectiveness of the punctate midline myelotomy performed in this one case of pelvic visceral pain suggests that the surgery may eventually be effective in greatly reducing or replacing opiate narcotic medication for visceral pain management.

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“…Midline myelotomy refers to a group of procedures, percutaneous or open method, consisting of the creation of central spinal cord lesions at different levels. [68][69][70][71][72][73][74][75][76] The first operation was performed by Hitchcock in 1968 to destroy the upper cervical commissural fibers and obtain analgesia in a patient suffering from pain in his neck and both arms caused by esophageal adenocarcinoma. 68 Hitchcock used 0.5-mm-diameter electrodes with a 1-mm open tip.…”

Section: Definition and Historymentioning

confidence: 99%

“…60,69 Papo and Luongo performed six to seven central cord lesions using 0.4-mm-diameter electrodes with a 2.5-mm open tip between the C1 and C3 segments. 72 Gildenberg and Hirshberg performed limited myelotomy with an open technique at the Th10 level for similar purposes. 73,74 Nauta and Becker used central cord lesioning by the open method at the Th7 and Th4 levels using a punctuate incision with a 16-gauge needle.…”

Section: Definition and Historymentioning

confidence: 99%

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

Kanpolat¹

2004

Seminars in Neurosurgery

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High cervical commissural myelotomy in the treatment of pain

Cited by 9 publications

References 4 publications

Commissural Myelotomy in the Treatment of Intractable Visceral Pain: Technique and Outcomes

Commissural Myelotomy in the Treatment of Intractable Visceral Pain: Technique and Outcomes

Surgical interruption of a midline dorsal column visceral pain pathway

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

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