Skip Navigation

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by COOK, A.W.
Right arrow Articles by SMITH, M. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by COOK, A.W.
Right arrow Articles by SMITH, M. C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Brain, Vol. 107, No. 2, 547-568, 1984
© 1984 Oxford University Press

research-article

SENSORY CONSEQUENCES OF COMMISSURAL MYELOTOMY*

A CHALLENGE TO TRADITIONAL ANATOMICAL CONCEPTS

A.W. COOK1, P.W. NATHAN2 and MARION C. SMITH2,3

1The Department of Neuroscience, Division of Neurosurgery, Long Island College Hospital Brooklyn, New York 2The National Hospital for Nervous Diseases Queen Square, London WC1N 3BG 3Radcliffe Infirmary Oxford

Twenty-five cases of commissural myelotomy were studied. Representative cases are reported, including a histological examination of the lesion in one. Although the purpose of the operation is to produce a cuirass of loss of pain sensibility by dividing the spinothalamic and spinoreticulothalamic fibres as they decussate in the anterior commissure of the cord, this result is not always obtained. Whether or not the expected sensory loss is obtained, the chronic pain for which the operation is performed can be relieved. Sensibility tends to return towards normal after myelotomy. Even with substantial recovery of sensory loss, the pain for which the operation was performed can remain absent. Asymmetrical sensory loss may be produced by the operation; reasons for this are suggested. Differences between the results of commissural myelotomy and anterolateral cordotomy are discussed.

Unlike the results of anterolateral cordotomy, which can be accounted for on the basis of known anatomy, the results of commissural myelotomy are inexplicable on present anatomical knowledge. Attention is drawn to the results of myelotomy reported originally by Hitchcock and confirmed by other neurosurgeons in which a short myelotomy incision in the upper cervical cord caused loss of pain over a vast region of the body. The difficulty in explaining the patterns of sensory loss in these cases is discussed. The literature on pathways alternative to the spinothalamic and spinoreticulothalamic is reviewed. It is argued that the central incision cannot cause relief of pain merely by cutting an afferent pathway, and it is suggested that this lesion blocks impulses entering into, in, or leaving the spinothalamic complex. The accurate localization of pinprick and thermal stimuli via the spinothalamic tract is demonstrated.

.

Received April 7, 1983. Revised September 8, 1983.

*Reprint request to Dr P. W. Nathan.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.