Amano K, Kawamura H, Tanikawa T, Kawabatake H, Iseki H, Taira T
Department of Neurosurgery, Tokyo Women's Medical College, Japan.
Stereotact Funct Neurosurg. 1992;59(1-4):25-32. doi: 10.1159/000098913.
Rostral mesencephalic reticulotomy (RMR) for pain relief was performed in 34 patients with intractable pain. Most of these patients have been followed for a long period of time postoperatively, the longest follow-up period being 11 years. Contrary to the commonly prevailed bias in the past that mesencephalotomy may be a surgical intervention with potential risk, these patients of RMR have continued to substantial improvement postoperatively in terms of their preoperative intractable painful dysesthesia after a long period of time. The results of pain relief for denervation pain as well as for nondenervation pain are surprisingly good even after unilateral procedures. There was no operative mortality. Postoperative disturbance of ocular motility has been reduced. RMR has its scientific basis in that the medial part of the reticular formation rather than the classical lateral spinothalamic tract has more significance in the central conduction of nociceptive impulses through the midbrain level, which was verified by intraoperative neuronal recording with a tungsten microelectrode. The present report emphasizes that stereotactic mesencephalotomy, if performed meticulously and precisely, is a safe surgical procedure for pain relief. Results of MRI and sensory manifestations of a patient 11 years after RMR are also presented.
对34例顽固性疼痛患者实施了用于缓解疼痛的延髓中脑网状结构切开术（RMR）。这些患者中的大多数在术后接受了长期随访，最长随访期为11年。与过去普遍存在的偏见相反，即中脑切开术可能是一种具有潜在风险的外科干预措施，这些接受RMR手术的患者在术后经过很长一段时间后，术前顽固性疼痛性感觉异常仍持续有显著改善。即使是单侧手术，去神经痛和非去神经痛的疼痛缓解效果也出奇地好。无手术死亡病例。术后眼球运动障碍有所减轻。RMR有其科学依据，即网状结构的内侧部分而非经典的外侧脊髓丘脑束在伤害性冲动通过中脑水平的中枢传导中具有更重要的意义，这一点通过术中用钨微电极进行神经元记录得到了证实。本报告强调，立体定向中脑切开术如果操作细致、精确，是一种安全的缓解疼痛的外科手术。还展示了一名患者在RMR术后11年的MRI结果和感觉表现。
