Is There Still Room in the Neurosurgical Treatment of Pain for Making Lesions in Nociceptive Pathways?

This chapter examines the question of whether there is a place for the surgical interruption of nociceptive pathways in the neurosurgical treatment of pain. Operations in the trigeminal nerve are frequently performed for trigeminal neuralgia, a frequent disorder which is possibly one of the most painful of all human afflictions. Microvascular decompression is a major intervention, and the most puzzling set of facts continues to be the similarity of results between minor maneuvers confined to the middle fossa, such as the percutaneous compression of the Gasserian ganglion, and those confined to the posterior fossa. Neurotomy has been used in a number of conditions such as painful neuroma, and thoracotomy pains. Owing to poor results, however, it has been almost entirely abandoned, except in a few conditions such as occipital neuralgia and particularly pseudoradicular pain, originating from the facets joints.