title: Stereotactic mesencephalotomy for palliative care pain control: A case report, literature review and plea to rediscover this operation.
abstract: Introduction Stereotactic mesencephalotomy is an ablative procedure which lesions the pain pathways (spinothalamic and trigeminothalamic tracts) at the midbrain level to treat medically refractory, nociceptive, contralateral pain. Sparsely reported in contemporary English language literature, this operation is at risk of being lost from the modern-day neurosurgical practice. Methods We present a case report and brief review of the literature on stereotactic mesencephalotomy. A 17-year-old girl with cervical cord glioblastoma and medically refractory unilateral head and neck pain was treated with contralateral stereotactic mesencephalotomy. The lesion was placed at the level of the inferior colliculus, half way between the lateral edge of the aqueduct and lateral border of the midbrain. Results The patient had no head and neck pain immediately after the procedure and remained pain-free for the remainder of her life (five months). She was weaned off her pre-operative narcotics and was able to leave hospital, meeting her palliative care goals. Conclusions Cancer-related unilateral head and neck nociceptive pain in the palliative care setting can be successfully treated with stereotactic mesencephalotomy. We believe that stereotactic mesencephalotomy is the treatment of choice for a small number of patients typified by our case. The authors make a plea to the palliative care and neurosurgical communities to rediscover this operation.
authors.affiliation: a Department of Surgery, Division of Neurosurgery , University of British Columbia , Vancouver , BC , Canada ;
authors.forename: Zurab
authors.initials: Z
authors.lastname: Ivanishvili
authors.affiliation: b Department of Neurosurgery, University of Leicester , Leicester , UK.
authors.forename: Shyam
authors.initials: S
authors.lastname: Pujara
authors.affiliation: a Department of Surgery, Division of Neurosurgery , University of British Columbia , Vancouver , BC , Canada ;
authors.forename: C Michael
authors.initials: CM
authors.lastname: Honey
authors.affiliation: a Department of Surgery, Division of Neurosurgery , University of British Columbia , Vancouver , BC , Canada ;
authors.forename: Stephano
authors.initials: S
authors.lastname: Chang
authors.affiliation: a Department of Surgery, Division of Neurosurgery , University of British Columbia , Vancouver , BC , Canada ;
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Honey
mesh_terms: D000293:Adolescent; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008636:Mesencephalon / Q000503:physiopathology / Q000601:surgery*; D009333:Neck / Q000503:physiopathology / Q000601:surgery; D059408:Pain Management; D010148:Intractable Pain / Q000601:surgery*; D010166:Palliative Care / Q000379:methods; D013238:Stereotaxic Techniques
keywords: Mesencephalotomy; midbrain; pain; palliative care; spinothalamic tract; trigeminothalamic tract