Y S Kim1, S J Kwon. 1. Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
Abstract
OBJECTIVE: To report the results of high thoracic midline dorsal column myelotomy in eight consecutive patients who experienced severe visceral pain caused by advanced stomach cancer. METHODS: Eight patients were transferred from the department of general surgery because of failed pain control after an operation and chemotherapy for advanced stomach cancer. Preoperatively, the pain was not controlled with strong opiates. The patients' neurological status was normal. Their general conditions varied from 50 to 80 on the Karnofsky scale. Under general anesthesia, patients received high thoracic midline dorsal column myelotomies after T1 or T2 laminectomy. RESULTS: Five of the eight patients exhibited favorable outcomes after surgery. The remaining three did not experience preoperative pain but developed new pain at a different site. One patient exhibited a posterior column sign and paresthesia below the level of the myelotomy without motor deficit and analgesia. Two patients exhibited transient paresthesia below the T6 level, but the paresthesia improved after administration of corticosteroids. There was no mortality related to the procedure. CONCLUSION: Controlling visceral pain resulting from advanced cancer is very difficult, although various surgical procedures have been tried. Poorly localized, deep and diffuse visceral pain is more difficult to manage than well-localized somatic pain. Dorsal column myelotomy at a high thoracic cord level effectively controls severe abdominal pain and should be considered as a new palliative operation for patients with severe visceral pain.
OBJECTIVE: To report the results of high thoracic midline dorsal column myelotomy in eight consecutive patients who experienced severe visceral pain caused by advanced stomach cancer. METHODS: Eight patients were transferred from the department of general surgery because of failed pain control after an operation and chemotherapy for advanced stomach cancer. Preoperatively, the pain was not controlled with strong opiates. The patients' neurological status was normal. Their general conditions varied from 50 to 80 on the Karnofsky scale. Under general anesthesia, patients received high thoracic midline dorsal column myelotomies after T1 or T2 laminectomy. RESULTS: Five of the eight patients exhibited favorable outcomes after surgery. The remaining three did not experience preoperative pain but developed new pain at a different site. One patient exhibited a posterior column sign and paresthesia below the level of the myelotomy without motor deficit and analgesia. Two patients exhibited transient paresthesia below the T6 level, but the paresthesia improved after administration of corticosteroids. There was no mortality related to the procedure. CONCLUSION: Controlling visceral pain resulting from advanced cancer is very difficult, although various surgical procedures have been tried. Poorly localized, deep and diffuse visceral pain is more difficult to manage than well-localized somatic pain. Dorsal column myelotomy at a high thoracic cord level effectively controls severe abdominal pain and should be considered as a new palliative operation for patients with severe visceral pain.
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