Stereotaxic pontine spinothalamic tractotomy

Our plain-English summary of Stereotaxic pontine spinothalamic tractotomy, by E.R. Hitchcock (Journal of Neurosurgery, 1973).

The study

• Author: E.R. Hitchcock
• Journal: Journal of Neurosurgery
• Published: 1973;39(6):746-52
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A stereotaxic method of radiocoagulation of the spinothalamic tract at the pontine level is described. A system of coordinates is presented for the spinothalamic tract in relation to the floor of the fourth ventricle. The advantages of tractotomy at this level are discussed, and the results presented in a small series of patients suffering intractable pain. In two cases the lesion has been verified histologically.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This single-author article from Edinburgh described a new operation for intractable pain, used in seven patients. It used a radiofrequency heat lesion to interrupt the pain pathway in the pons. It is not an asbestos study and mentions no asbestos exposure. Six patients had cancer pain. One, a 53-year-old man, had right chest pain due to mesothelioma with invasion of the right chest and mediastinum. The lesion gave him complete analgesia of the right neck, arm, chest, abdomen and upper leg, with only a slight left ptosis. He then developed paraplegia from tumor in the spinal cord and died on December 15, 1971. Some others had complete pain relief. In another man, analgesia had shrunk within two weeks and he continued in great distress, presumably from further tumor invasion. The author called one other outcome unsatisfactory. Side effects included eye-muscle palsies and facial and limb weakness. The one patient without cancer was still pain-free in October 1973. The author concluded the procedure was feasible but should be used only if simpler cordotomy methods were considered and found unadvisable.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Description of a new surgical technique with a case series of seven patients (individual case reports)
• Who was studied: Seven patients (aged 35 to 79) with intractable pain, operated on at the Department of Surgical Neurology, Western General Hospital, Edinburgh, between February and November 1971. Six had cancer-related pain. One (Case 6) had leg pain from a lumbar wound infection and nerve root adhesions. Case 7 was a 53-year-old man with mesothelioma.
• Exposure: No asbestos or fiber exposure is described. The intervention studied was a stereotaxic radiofrequency lesion (radiocoagulation) of the spinothalamic tract at the level of the pons.
• Main results:
  • Case 7 (mesothelioma): the lesion produced complete analgesia of the right neck, arm, chest, abdomen and upper leg, with no other neurological disorder apart from a slight left ptosis.
  • Case 7: a few days after surgery the patient developed increasing paraplegia. Myelography showed gross infiltration of the spinal cord by tumor, and he died on December 15, 1971.
  • Case 7: on brain sectioning, the center of the lesion was about 6.3 mm from the midline, an error of 1.2 mm from the calculated setting.
  • Case 2 (79-year-old man, supraclavicular carcinoma): the lesion produced complete pain relief. Afterwards he had difficulty swallowing and right facial weakness, and he died of sudden cardiac arrest nine days after surgery.
  • Case 3 (57-year-old man, metastatic laryngeal cancer): he was initially pain-free. Two weeks after surgery he developed paralysis and pain in the left arm, which the author presumed was due to further invasion of the brachial plexus. Analgesia was then limited to the left leg below the knee, and he continued in great distress until his death on May 6, 1971.
  • Case 4 (49-year-old man, rectal carcinoma metastases): the author judged the result unsatisfactory because no sensory loss was obtained, a sixth nerve paresis occurred, and pain relief was poorly sustained.
  • Case 6 (35-year-old woman with non-cancer lumbar pain): she remained pain-free as of October 1973, although the analgesic level had faded somewhat and she still had spasmodic contractions of the left toes.
  • The lesion was verified histologically in two of the seven cases.
• The authors' conclusion: The author concluded that stereotaxic pontine tractotomy is a feasible and relatively straightforward procedure. The author added that it should not be undertaken unless simpler methods such as open or percutaneous cordotomy have been considered and found unadvisable.
• Limitations the authors state:
  • The results come from a small series of patients.
  • Measurements of the lesion in Case 7 were probably subject to an error of about plus or minus 1 mm because of shrinkage and distortion during fixation.
  • Complications occurred in earlier cases. The author stated that these were reduced with more accurate placement and more restricted lesions as experience increased.

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