A medullary tractotomy is most commonly done for intractable facial pain associated with a malignancy. Occasionally it will be the procedure of choice in trigeminal neuralgia. This operation interrupts the pain fibers in the descending spinal tract of V. Since fibers in this tract carrying pain messages descend as low as C3, it is possible to abolish pain with an incision five mm. below the obex. Because sensory components of VII, IX and X also descend in the spinal tract of V just medial to the mandibular division, pain deep within the ear can be relieved by this operation. This operation also has the advantage of being technically quite simple.
KeywordsTrigeminal Neuralgia Scalpel Blade Cerebellar Tonsil Sensory Component Spinal Tract
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