Tractotomy and partial vertical nucleotomy--for treatment of special forms of trigeminal neuralgia and cancer pain of face and neck.

Abstract

The therapy of face and neck pain has often been elusive. We attempted to improve the condition of these patients and tried to influence 1. pain of trigeminal neuralgia, where other forms of therapy had failed, 2. pain due to tumours in the distribution of the Vth, IXth and Xth nerve, when all other methods had proved to be unsuccessful, 3. pain due to a traumatic lesion of the Vth nerve after severe injury of the face and 4. pain in the first division of the Vth nerve after herpes zoster infection, when other forms of therapy had failed. After tractotomy the subnucleus caudalis n.V. is partially destroyed. Aim of the partial vertical nucleotomy is the interruption between the first and second neuron of the Vth nerve conveying pain and thermal sensibility, but also of the IXth and Xth nerve, which end in the subnucleus caudalis n.V. as well. Tactile and some thermal sensibility in the face is so retained, and anesthesia dolorosa or keratitis neuroparalytica avoided. Medially of and vertically to the tractotomy a 4-6 mm long incision both cranially and caudally of the tractotomy was made. For the first division of the Vth nerve the nucleotomy is performed on the lateral end of the tractotomy incision. In the patients with cancer of the face and neck a rhizotomy C 1/2 was added. 7 of the 12 patients with trigeminal neuralgia and 3 of the 6 patients with tumors of the face and neck were pain-free. The rest also showed a marked improvement.(ABSTRACT TRUNCATED AT 250 WORDS)