Experience with Topectomy for the Relief of Intractable Pain

Abstract

Bilateral topectomy (involving roughly areas 9, 10 and 46 of the frontal cortex) was performed on 25 patients suffering from different kinds of unbearable pain. Results were generally good if a total of 25-30 g. of cortical tissue were removed. Unilateral topectomy has proven much less successful. The author introduces the term "souffrance" for the disturbance of cerebral function encountered in cases of intolerable pain. There was always a close parallel between souffrance and anxiety. The effect of topectomy involving areas 9, 10 and 46 appeared to be rather specific for souffrance and anxiety. The patients were not disturbed in other aspects of mental activity, an advantage of topectomy over leucotomy. It is suggested that frontal topectomy owes its beneficial results to interruption of a circuit which involves three relays[long dash]dorsomedial nuclei of thalamus, granular frontal cortex, and hypothalamus. An objective method of measuring unpleasant and unbearable pain is descr., based on the appln. of localized pressure to body surfaces.