Stereotactic rostral mesencephalotomy in cancer pain and deafferentation pain. A series of 40 cases with follow-up results

Stereotactic rostral mesencephalotomy was performed in two groups of patients to investigate the long-term results in regard to pain relief. A standardized technique of target localization with ventriculography was used. Group A consisted of 33 patients with otherwise intractable pain due to cancer. Group B consisted of seven patients with deafferentation pain. Long-term pain relief was good (57%) for Group A and nonexistent for Group B patients. It is concluded that stereotactic rostral mesencepthalotomy is a valuable means for treating nociceptive cancer pain in lateral syndromes, but is of no value in neuropathic pain. Anatomical correlates for the results obtained are discussed and a hypothesis on the plasticity of the neo- and paleospinal afferent systems is formulated.