title: Punctate midline myelotomy for intractable visceral pain caused by hepatobiliary or pancreatic cancer.
abstract: 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.
authors.affiliation: Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Shiuh-Lin
authors.initials: SL
authors.lastname: Hwang
authors.forename: Chih-Lung
authors.initials: CL
authors.lastname: Lin
authors.forename: Ann-Shung
authors.initials: AS
authors.lastname: Lieu
authors.forename: Tai-Hung
authors.initials: TH
authors.lastname: Kuo
authors.forename: Kwong-Leung
authors.initials: KL
authors.lastname: Yu
authors.forename: Fu
authors.initials: F
authors.lastname: Ou-Yang
authors.forename: Shen-Nien
authors.initials: SN
authors.lastname: Wang
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.forename: Shen-Long
authors.initials: SL
authors.lastname: Howng
mesh_terms: 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