Neurosurgical treatments of pain--a general survey

Various ablative procedures for the relief of intractable pain have been briefly described in the previous sections. In Table 5, common types of pain and the procedures which the author thinks indicated for those types are listed. For the relief of cancer pain, if it is unilateral and involving the trunk and extremities, percutaneous cordotomy may be the procedure of choice. If cancer involves the head and neck or the body bilaterally, stereotaxic mesencephalotomy or stereotaxic posteromedial hypothalamotomy may be indicated. For deafferentation pain, dorsal root entry zone lesion, or if it involves the face, trigeminal spinal nucleotomy may be most suitable. Thalamic pain is difficult to treat. Stereotaxic thalamolaminotomy and/or vim-tomy may be worthwhile trying. Other central pain may be treated by thalamolaminotomy. Trigeminal neuralgia is best treated by microvascular decompression. If the patient's condition does not permit this rather major procedure, it can be treated by percutaneous thermocoagulation of the Gasserian ganglion or glycerol injection into the trigeminal cistern. Glossopharyngeal neuralgia is also effectively treated by microvascular decompression or by percutaneous thermocoagulation of the petrous ganlion. The neurosurgeon should always bear in mind that effects of ablative procedures may be temporary, and must adopt the best possible procedure for the patient according to his general conditions and his disease.