Cancer-related
facial pain refractory to pharmacologic management or nondestructive means is a major indication for destructive
pain surgery. Stereotactic mesencephalotomy can be a valuable procedure in the management of
cancer pain involving the upper extremities or the face, with the assistance of magnetic resonance imaging (MRI) and electrophysiologic mapping. A 72-year-old man presented with a 3-year history of intractable left-sided
facial pain. When pharmacologic and nondestructive measures failed to provide
pain alleviation, he was reexamined and diagnosed with inoperable hard palate
cancer with intracranial extension. During the concurrent chemoradiation treatment, his
cancer-related
facial pain was aggravated and became medically intractable. After careful consideration, MRI-based stereotactic mesencephalotomy was performed at a point 5 mm behind the posterior commissure, 6 mm lateral to and 5 mm below the intercommissural plane using a 2-mm
electrode, with the temperature of the
electrode raised to 80℃ for 60 seconds. Up until now, the
pain has been relatively well-controlled by intermittent intraventricular
morphine injection and oral
opioids, with the
pain level remaining at visual analogue scale 4 or 5. Stereotactic mesencephalotomy with the use of high-resolution MRI and electrophysiologic localization is a valuable procedure in patients with
cancer-related
facial pain.