INTRAMEDULLARY TRIGEMINAL TRACTOTOMY AND ITS PLACE IN THE TREATMENT OF FACIAL PAIN

Abstract

20 cases in which intramedullary section of the descending tract of the trigeminal was made to relieve facial pain are described. Section was made somewhat caudal to the level of the obex under local anesthesia after localization of the tract by needle puncture. The tract subserves pain and temp. sensibility from Cr. VII, DC, and X as well as Cr. V. The ophthalmic division is ventro-lateral in tract lamination, the maxillary intermediate and the mandibular dorso-medial. Mandibular fibers leave first at or somewhat below the level of the obex, followed by the maxillary and then the ophthalmic. The site of incision may have to be cephalized to the level of the obex to abolish pain in the mandibular division, a section 4 mm. caudal sufficing for the ophthalmic and maxillary divisions.