Original communication| Volume 9, ISSUE 2, P183-193, February 1941

Section of the spinothalamic tract in the medulla with observations on the pathway for pain

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      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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