頭痛症に対する脳神経外科的手術の進歩について(<特集>脳と神経の研究V)

概要

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Previous surgical procedures devised for intractable pain are the excision of painful area of the skin, peripheral neurotomy, intraspinal or intracranial posterior rhizotomies, anterolateral spinal cordotomy, spinothalamic tractotomy at medulla and mesencephalon for the pain of organic origin, and the prefrontal lobotomy for psychogenic pain. Unfortunately, these procedures are followed either by disturbance of physiologic sensory function or by changes of affect and personality. Partial gasserian gangliolysis successfully alleviated the trigeminal neuralgia without significant sensory disturbance of the face. Recent advances in stereotaxic technique has enabled us to attack the thalamus and other deep subcortical centers. This new method, together with recent neuroanatomico-physiological progress in regard to "pain tract" through intralaminar nuclear complex, resulted in discovery of thalamotomy destroying the nucleus centrum medianum with or without adjacent intralaminar nuclei, which eliminates the organic pain without any detectable sensory deficit. Anterior cingulectomy or cingulumotomy has developed to alleviate the psychogenic pain without psychological changes. These are the ideal pain-relieving procedures. A new method of percutaneous cervical cordotomy can be safely used for the debilitated patients with terminal malignant diseases.
千葉大学の論文