Broggi G, Dones I, Ferroli P, Franzini A, Pluderi M
Département de Neurochirurgie, Istituto Nazionale Neurologico C. Besta, Via Celoria 11, I-20133 Milan, Italie.
Neurochirurgie. 2000 Nov;46(5):447-53.
Ablative neurosurgical methods are mainly proposed in cases of nociceptive pain, but, at present, medical treatments and local pharmacotherapy (intrathecal and intracerebroventricular) are often very effective in this context. Moreover, neuropathic pain is well controlled by äugmentative techniques, except painful paroxysms. If a destructrive method is necessary, it is selective, performed according to precise neurophysiological and anatomical data with the frequent use of percutaneous and/or stereotactic techniques: the lesion of caudalis DREZ in treatment of neuropathic trigeminal pain, the antero-lateral cordotomy in the treatment of unilateral severe cancer pain and several kinds of thalamotomy.
切除性神经外科手术方法主要用于伤害感受性疼痛的病例，但目前，在这种情况下，药物治疗和局部药物疗法（鞘内和脑室内）往往非常有效。此外，除了疼痛发作外，神经性疼痛可通过增强技术得到很好的控制。如果需要采用破坏性方法，则是选择性的，根据精确的神经生理学和解剖学数据进行，经常使用经皮和/或立体定向技术：在治疗神经性三叉神经痛时损伤尾侧背根入髓区，在治疗单侧严重癌痛时进行脊髓前外侧切断术以及几种丘脑切开术。
