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Further experience in stereotactic pontine tractotomy.

The problem with percutaneous and even stereotactic cordotomy is the difficulty in obtaining sufficiently high analgesic levels without autonomic complications, although the problem seemed to apply to relatively few patients since percutaneous and stereotactic spinal procedures achieved sufficiently high analgesic levels to encompass most patients' pain. There is a group of patients, however, with high pain in the shoulder and neck where conventional percutaneous and stereotactic spinal procedure are dangerous. From the standpoint of achieving high levels of analgesia with a low incidence of dysaesthesia, pontomedullary lesions appear to have advantages.