Sensory, motor, and reflex changes in two cases of intractable pain after stereotactic mesencephalic tractotomy.

Section of the spinoand trigeminothalamic fibres at the level of the mesencephalon for intractable pain was first performed by Dogliotti (1938). A few years later Walker (1942a) developed a standard technique for section of the pain fibres at the level of the posterior margin of the superior colliculus, and later several cases of mesencephalic tractotomy were published (Guiot and Forjaz, 1947; David, Talairach, and Hecaen, 1947; Sj6quist, 1949; Walker, 1950; Schwartz, 1950; White and Sweet, 1955). Since this procedure involves a somewhat high mortality, attempts have been made at the Neurosurgical Clinic in Lund to destroy the spinothalamic tract at mesencephalic levels by stereotactic methods. So far the operation has been tried in only a few cases. The present report represents an analysis of the neurological and necropsy findings in two patients. Both cases presented were operated upon by Professor Leksell in Lund. The technique and apparatus employed have been described elsewhere (Leksell, 1957), and will only be briefly commented upon below.