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Abstract
A case is reported in which section of the spinothalamic tract in the medulla was
performed for relief of high, intractable pain. The operative technique is described.
On the basis of sensory changes which resulted, it is concluded that a topical arrangement
of fibers is present in the spinothalamic tract, with fibers from the lower dermatomes
occupying a dorsolateral position and those from the upper segments lying ventromedially.
À lesion involving the ventrolateral portion of the descending trigeminal tract was
associated with disturbance of sensation in the distribution of the mandibular division
of the fifth nerve.
Since this report was accepted for publication, Dr. James C. White (personal communication),
of Boston, has confirmed the efficacy of the procedure, successfully relieving pain
in a patient suffering from Raynaud's disease.
We have had additional experience in a second case of advanced malignant disease,
in which the left spinothalamic tract was cut at the level of the inferior olive.
This resulted in complete alleviation of pain in the right chest, shoulder, and axilla,
caused by inoperable carcinoma of the breast with metastases. There was no involvement,
indicating that the lesion extended into the neighboring descending tract of the trigeminal
nerve, the nucleus ambiguus, medial lemniscus or vagal autonomic centers. We were
able to confirm our previous opinion concerning topical localization of pain fibers
within the spinothalamic tract in the brain stem. The patient was discharged from
the Neurosurgical Service of the St. Louis City Hospital and was free of pain until
her death from carcinoma one month later. Details of this case will be reported in
a subsequent communication.
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Article info
Publication history
Received:
May 1,
1940
Footnotes
☆Presented before the Society of Neurological Surgeons at the St. Louis meeting, April 29, 1940.
Identification
Copyright
© 1941 Published by Elsevier Inc.
