Abstract
Introduction.Nautaet al.first reported on a successful punctate midline myelotomy (PMM) at the spinal cord Th 10 level for the treatment of intractable pelvic cancer pain.
Case Study.The authors published another case history of a patient with multiple anaplastic carcinomas of the small intestine, peritoneal carcinosis and retroperitoneal lymphomas, suffering from severe visceral pain in the hypo-, meso-, and epigastrium. Nauta’s PMM was successfully performed at the level Th 4. Narcotic medication was tapered from 30 mg iv. morphine per hour preoperatively to 5 mg per hour within 5 days postoperatively. Pain intensity decreased from 10 to 2–3 on the visual analog scale. Only minor transient side effects appeared postoperatively. Pain reduction remained until the patient died from the extended disease five weeks later.
Discussion.Meanwhile Nautaet al.reported on 5 additional patients, in whom PMM led to a sufficient pain reduction. Another paper reported on sufficient control of visceral pain due to advanced stomach cancer after a modified Th 1–2 PMM.
Conclusion.PMM sufficiently controls not only pelvic visceral pain, but also visceral pain generated in the meso-and epigastrium. The findings support the concept of a midline dorsal column visceral pain pathway.
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References
Al-Chaer ED, Lawand NB, Westlund KN, Willis WD (1996) Visceral nociceptive input into the ventral posterolateral nucleus of the thalamus: a new function for the dorsal column pathway. J Neurophysiol 76(4): 2661–2674
Becker R, Sure U, Bertalanffy H (1999) Punctate midline myelotomy: a new approach in the management of visceral pain. Acta Neurochir(Wien) 141: 881–883
Hirshberg RM, Al-Chaer ED, Lawand NB, Westlund KN, Willis WD (1996) Is there a pathway in the posterior funiculus that signals visceral pain? Pain 67(2–3): 291–305
Kim YS, Kwon SJ (2000) High thoracic midline dorsal column myelotomy for severe visceral pain due to advanced stomach cancer. Neurosurgery 46(1): 85–90
Nauta HJ, Hewitt E, Westlund KN, Willis WD Jr (1997) Surgical interruption of a midline dorsal column visceral pain pathway. Case report and review of the literature. J Neurosurg 86(3): 538–542
Nauta HJ, Soukup VM, Fabian RHet al(2000) Punctate midline myelotomy for the relief of visceral cancer pain. J Neurosurg 92 [Suppl] 2: 125–130
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© 2002 Springer-Verlag Wien
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Becker, R., Gatscher, S., Sure, U., Bertalanffy, H. (2002). The Punctate Midline Myelotomy Concept for Visceral Cancer Pain Control—Case Report and Review of the Literature. In: von Wild, K.R.H. (eds) Functional Rehabilitation in Neurosurgery and Neurotraumatology. Acta Neurochirurgica Supplements, vol 79. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6105-0_17
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