Open Mesencephalotomy and Thalamotomy for Intractable Pain

Severe, protracted pain defying control is being seen with in creasing frequency as a symptom of chronic disease. It accompanies many, mostly serious, disorders in various organs and parts of the human body, making the sufferer's life increasingly intolerable. It no longer fulfillR its mission of warning signal of disease present, protecting health, but on the contrary arises as an important factor in systematically reducing and preparing the final collapse of the defensive forces of the body, both in the somatic and psychic spheres. It can surprise nobody that patients tormented and plagued by severe pain do not wish to live under conditions primarily caused by incurable disease, and are looking forward longingly to their release by deat. h, if no help is forthcoming. Attempts to control such pain are, therefore entirely justified, necessary and logical. The treatment of intractable pain is without exception sympto matic in character. Efforts to control it by drugs are, even at present and despite the striking progress in pharmacology, unsatisfactory and inadequate. So far we know of no drug capable of effectively and systematically alleviating such pain without concurrently inter fering with the other sensitive-sensory components. In addition to the direct changes and dist. urbances of consciousness and personal ity, protracted conservative therapy results in addiction to narcot ics.

Klappentext

Severe, protracted pain defying control is being seen with in­ creasing frequency as a symptom of chronic disease. It accompanies many, mostly serious, disorders in various organs and parts of the human body, making the sufferer's life increasingly intolerable. It no longer fulfillR its mission of warning signal of disease present, protecting health, but on the contrary arises as an important factor in systematically reducing and preparing the final collapse of the defensive forces of the body, both in the somatic and psychic spheres. It can surprise nobody that patients tormented and plagued by severe pain do not wish to live under conditions primarily caused by incurable disease, and are looking forward longingly to their release by deat. h, if no help is forthcoming. Attempts to control such pain are, therefore entirely justified, necessary and logical. The treatment of intractable pain is without exception sympto­ matic in character. Efforts to control it by drugs are, even at present and despite the striking progress in pharmacology, unsatisfactory and inadequate. So far we know of no drug capable of effectively and systematically alleviating such pain without concurrently inter­ fering with the other sensitive-sensory components. In addition to the direct changes and dist. urbances of consciousness and personal­ ity, protracted conservative therapy results in addiction to narcot­ ics.

Inhalt
I. Introduction.- II. A History of Operations on the Mesencephalon and Thalamus.- III. The Anatomy and Physiology of the Mesencephalon and Thalamus from the Viewpoint of Surgical Ccntrol of Pain.- 1. The Anatomy and Physiology of the Midbrain.- 2. The Course of the Pain Tract in the Medulla and Brain Stem.- 3. The Blood Supply of the Mesencephalon.- 4. The Anatomy and Physiology of the Thalamus.- 5. Posterior Structures of the Thalamus.- 6. The Lateral Part of the Thalamus.- 7. Terminations of the Pain Tracts.- 8. The Medial Part of the Thalamus.- 9. The Truncothalamic System.- 10. The Extrathalamic Terminations of Pain Fibres.- 11. The Pathophysiological Theories of the Central Pain.- 12. The Blood Supply of the Thalamus.- IV. Surgical Technique.- 1. Walker's Approach to the Mesencephalon.- 2. Guiot's and Forjaz's Modification of the Walker's Operation.- 3. The Author's Infratentorial Approach.- 4. Stereotaxis.- 5. Technique of Destructions in the Mesencephalon.- 6. Technique of the Open Mesencephalothalamotomy.- 7. Stereotactic Destructions.- 8. Technique of Open Thalamotomy.- 9. The Extent of Thalamic Destructions. The Partial Longitudinal Thalamotomy.- 10. Side-effects and Complications of Mesencephalotomies and Thala-motomies.- 11. Stimulation of Pain Pathways at the Brain Stem Levels.- 12. Anatomical and Histological Findings.- V. Clinical Results.- 1. Indications for the Brain Stem Operations and the Division of Patients for the Resultant Evaluation.- 2. The Classical Walker's Operation.- 3. The Author's Clinical Results with Mesencephalotomy.- 4. Stereotactic Mesencephalotomy.- 5. The Open Mesencephalothalamotomy.- 6. Stereotactic Thalamotomy.- 7. The Open Thalamotomy.- VI. Evaluation of Mesencephalotomy and Thalamotomy and Their Comparisonwith Other Surgical Methods.- 1. Operations in the Region of the Frontal Lobes.- 2. The Upper Cervical Chordotomy.- 3. Medullary Tractotomy.- 4. Mesencephalic Tractotomy.- 5. Mesencephalothalamotomy.- 6. Stereotactic Thalamotomy.- 7. The Problem of Bilateral Interventions.- 8. The Advantages and the Future of Thalamic Destructions.- VII. Conclusion.- References.