Stereotactic mesencephalic tractotomy in the treatment of chronic cancer pain.

A report is given on indications and results of treatment of chronic cancer pain using stereotactic mesencephalic tractotomy (SMT), based on own experiences in 202 patients. Percutaneous cervical cordotomy for upper body pain syndromes has been abandoned and replaced by SMT. Operative mortality of SMT was less than 0.5%, and also its morbidity was low and usually transitory. Bilateral procedures may be performed with an interval of at least seven days. Early recurrences within one month (15%) are due to insufficient coagulation. Late pain recurrence occurred in 4% and may be due to either nervous system regeneration (sprouting) or transmission of pain by alternate secondary pathways.