Long-Term Results of Central Stereotactic Interventions for Pain

Abstract

The treatment of chronic pain and pain due to malignant tumours is one of the problems dealt with by functional neurosurgery. The traditional use of the cordotomy and tractotomy performed either with the percutaneous or the stereotactic puncture technique has been supplemented in recent years by direct, permanent radio-stimulation of interneuronal connections on the dorsal surface of the spinal medulla (so-called dorsal column stimulation). Apart from these procedures performed at the periphery, we have been carrying out stereotactic interventions on the structures of the central nervous system itself since 1952 in Freiburg. Beginning in April 1952 one of the authors (MUNDINGER) operated 137 patients with intractable pain (Fig. 1), by stereotaxy. The first such operation was performed on the primary sensory nuclei together with RIECHERT following a suggestion by HASSLER (5, 6, 7, 9). The proportion of operations for pain is small in relation to the total number of stereotactic operations: 5, 112 of these were performed up till February 28, 1975 (1, 2, 10, 12, 13). The reason for this is that from the outset we have severely restricted the indications for central pain operations.