Brainstem

Vertical Dorsal

Corticospinal spinocerebellar spinocerebellar tract tract tract

Vertical Dorsal

Corticospinal spinocerebellar spinocerebellar tract tract tract

Figure 13.39 Cross section of spinal cord at C1-C2 showing the spinothalamic tract and window detailing the somatotopic organization. Probe on left side for percutaneous radiofrequency.

Lateral spinothalamic tract

Figure 13.39 Cross section of spinal cord at C1-C2 showing the spinothalamic tract and window detailing the somatotopic organization. Probe on left side for percutaneous radiofrequency.

Figure 13.40 Analgesic area after C1-C2 unilateral left cordotomy.

To thalamus and frontal lobe

To thalamus and (involved in emotion somatic sensory cortex and suffering)

To thalamus and (involved in emotion somatic sensory cortex and suffering)

Figure 13.41 A delta and C-fibers decussate in the spinal cord and ascend in the spinothalamic tract to the midbrain where they can be lesioned under sedation guided by magnetic resonance imaging (MRI).

matter or the reticular formation. An additional tract that may be lesioned is the quintothala-mic tract. It is located superomedial to the spinothalamic tract. This decreases transmission of extralemniscal emotional suffering. The best results have been using stereotactic approaches for the treatment of nociceptive head and neck pain secondary to malignancy and neuropathy. The main untoward side effects are dysesthesias and oculomotor dysfunction (Fig. 13.41).

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