Mesencephalotomy, How I Do It: Analysis of 34 Cases

The present paper aims to demystify the use of rostral mesencephalic reticulotomy (mesencephalotomy) in the treatment of chronic pain in cancer patients. A retrospective review of the medical records from the Central Pain and Stereotaxy Department of the A. C. Camargo Cancer Center, São Paulo, state of São Paulo, Brazil, between 2005 and 2012, was performed. Surgical indication was restricted to patients with cancer pain refractory to etiological and symptomatic treatments, > 2 months of expected survival, preserved cognition, and absence of coagulation disorders, of systemic infection, and of intracranial hypertension. We have selected 34 patients, with an average follow-up of 9.4 months, an average age of 54.3 years-old, and an average follow-up time until death of 6.4 months. Lung cancer was themost frequent diagnosis. Satisfactory and immediate pain relief was achieved in 91% of the cases, and 83% of these patients had no relapses. Among the complications, ocular movement disorder was the most frequent, but often transient. Permanent disturbances occurred in 8.8% of the cases (diplopia, rubral tremor, and paresthesia). Compared to the pharmacological treatment, mesencephalotomy was economically feasible, more effective, and improved quality of life. According to the data presented, it can be concluded that mesencephalotomy is a viable procedure for cancer pain control in selected cases.

Effects of mesencephalic lesion on testes, seminal vesicles and adrenal glands of albino rats.

The role of mesencephalic reticular formation on testicular structure, seminal vesicles, adrenal glands and kidneys of albino rats was investigated. Mesencephalic reticular formation lesions were produced using two epoxy-coated stainless steel electrodes. Electrolytic lesions resulted in atrophy of the testes, seminal vesicles and adrenal glands. The degree of atrophy was statistically significant in these organs (P < 0.01). However, there were no significant changes in the kidneys of lesioned animals. This study strongly suggests that the mesencephalic reticular formation influences the histomorphology of testes, seminal vesicles and adrenal glands.