Punctate midline myelotomy for intractable visceral pain caused by hepatobiliary or pancreatic cancer.
The purpose of this study was to demonstrate the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pain resulting from hepatobiliary or pancreatic cancer. A punctate midline myelotomy (PMM) of T(3) level was performed in 6 patients who experienced severe visceral pain caused by hepatobiliary or pancreatic cancer. Preoperatively, the pain was refractory to strong opioids. Clinical efficacy of PMM was evaluated by comparing patient pain rating on a visual analogue scale. Follow-up periods ranged from 2-18 weeks after operation. All 6 patients had immediate pain relief after operation. Although the pain recurred from 2-12 weeks later in 3 patients, the severity of recurrent cancer pain markedly decreased. No adverse neurological sequelae were observed. Our results of high thoracic PMM offer clinical support for the concept that neurosurgical interruption of midline visceral pain pathway can effectively control severe visceral pain without causing adverse neurological sequelae in patients with hepatobiliary or pancreatic cancer.
Hwang
Shiuh-Lin
SL
Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Lin
Chih-Lung
CL
Lieu
Ann-Shung
AS
Kuo
Tai-Hung
TH
Yu
Kwong-Leung
KL
Ou-Yang
Fu
F
Wang
Shen-Nien
SN
Lee
King-Teh
KT
Howng
Shen-Long
SL
D000368:Aged; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002818:Cordotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology* / Q000601:surgery*; D014781:Viscera