Punctate midline myelotomy for the relief of visceral cancer pain

Haring J. W. Nauta Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 M.D., Ph.D.
,
Vicki M. Soukup Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 Ph.D.
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Roderic H. Fabian Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 M.D.
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James T. Lin Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 M.D.
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James J. Grady Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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Courtney G. A. Williams Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 M.D.
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Gerald A. Campbell Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 M.D., Ph.D.
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Karin N. Westlund Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 Ph.D.
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William D. Willis Jr. Division of Neurosurgery, Departments of Neurology, Internal Medicine, Preventive Medicine and Community Health, Anesthesiology, Pathology, and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, Texas

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 M.D., Ph.D.
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125–130
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Volume 92: Issue 2
DOI link:
https://doi.org/10.3171/spi.2000.92.2.0125
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Object. This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies.

Methods. A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination.

Conclusions. These findings provide corroborating clinical evidence for the existence of a newly recognized mid-line posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.

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Contributor Notes

Address reprint requests to: Haring J. W. Nauta, M.D., Ph.D., Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas 77555–0517. email: svansitt@utmb.edu.
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