頑痛に対するFrontal Cryocingulumotomy

TREATMENT OF INTRACTABLE PAIN BY FRONTAL CRYOCINGULUMOTOMY

I．緒言

　癌またはそれに類似する疾患を有する患者で，疼痛を訴える者に対して，これを治療することは医業にたずさわる者にとつて，はなはだやつかいな問題のひとつである。モルフィネその他の麻薬の使用もそれに対するひとつの処置ではあるが，患者の経過が少し長びいた場合，その習慣性に対する処置がいつそう困難となることは多くの人の経験するところである。FoltzおよびWhite^1）2）3）は多くの実験的，臨床的経験よりfrontal cingulum fasciculusの破壊がいわゆるintractable painに対して鎮静的効果を示すことを発表したが，私どもも癌末期患者ならびにそれに類似する疾患を有する患者でintractable　painを訴える者に対して，この方法を試み，著効を得たと考えるのでここに報告する。

Relief of intractable pain is one of the most diffi-cult problems for clinicians to resolve. Drug therapy and destructive operations of pain-conducting path-ways of the peripheral or central nervous system are not yet satisfied.

According to E. L. Foltz and L. E. White, transec-tion of the cingulum or cingulumotomy is of benefit in those clinical cases of intractable pain in which marked emotional factors apper to contribute to the intolerable situation.

In their project, we have stereotaxically tried frontal cingulumotomy by cooling destruction in five cases suffering from intractable pain and incurable diseases. We named this method of destruction cryo-cingulumotomy after the cryosurgery equipment which was devised by I. S. Cooper.

In standpoint of clinical view, excellent result was obtained in three, good in one and fair in one. His-toanatomical verification was done postmortem in four out of five. It revealed that proper bilateral cryocingulumotomy seemed to be successful in relief of the pain in these cases in comparison with the unilateral procedure. We can emphasize this cryo-cingulumotomy is simple and safe, and does not leave any neurological disturbances. In this point we might think our cryocingulumotomy should be first of all attempted to the patients who are suffering from incurable diseases and excruciating pain.