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Tractotomy
A patient undergoing stereotactic trigeminal nucleotractotomy
SpecialtyNeurosurgery,
cardiothoracic surgery
UsesTreat intractable pain,
movement disorders,
psychiatric illnesses,
traumatic lung injuries
TypesTrigeminal nucleotractotomy,
mesencephalic tractotomy,
spinothalamic tractotomy,
pallidothalamic tractotomy,
subcaudate tractotomy,
pulmonary tractotomy

Tractotomy is a surgical procedure that disrupts specific pathways in the nervous system by intentionally creating small cuts. It aims at managing intractable pain, movement disorders, and severe psychiatric illnesses which conventional therapies cannot remedy. In the context of traumatic injury, tractotomy also refers to a surgical procedure with minimal lung tissue removal.

In neurosurgery, trigeminal nucleotractotomy, mesencephalic tractotomy, and spinothalamic tractotomy address pain, while pallidothalamic tractotomy and subcaudate tractotomy tackle movement disorders and psychiatric illnesses respectively. Meanwhile, in chest surgery, pulmonary tractotomy is used to manage deep, penetrating lung wounds.

While risks and complications vary according to specific surgical pathways, recovery times are determined by whether an open, stereotactic, or percutaneous approach is used — a progression driven by continuous technological innovation.

Classifications of tractotomy

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Nervous system

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Intractable pain

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Trigeminal nucleotractotomy
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Trigeminal nucleotractotomy is a modern surgical procedure designed to treat long-lasting facial pain. It combines two methods: trigeminal tractotomy, which interrupts the lateral descending trigeminal tract, and trigeminal nucleotomy, which destroys the spinal trigeminal nucleus.[1][2] Both structures serve as pathways to transmit pain sensations from the face to the brain.[1][2] This procedure is commonly used for conditions such as postherpetic neuralgia, craniofacial cancer pain, poststroke pain, and trigeminal neuropathic pain.[1]

Pain pathways encompassing the trigeminal and spinothalamic tract

After local anesthesia is administered, lumbar myelography (an imaging technique) is performed by injecting a “contrast dye” into a fluid-filled space around the spinal cord via lumbar puncture. This allows for detailed scans of the area between the first cervical vertebra and the base of the skull (C1-occiput region).[2] A thin needle is then carefully inserted into the fluid-filled space in the C1-occiput region to guide the placement of an electrode into the target area where pain signals are processed.[2] The accuracy of the electrode placement is further confirmed by electrical stimulation.[2] Finally, radiofrequency lesions are applied to the target site, using heat to destruct localized areas responsible for transmitting pain signals.[2]

Mesencephalic tractotomy
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A stereotactic frame attached to a patient’s skull for precise surgical targeting

Mesencephalic tractotomy, or mesencephalotomy, is used for patients with cancer-related pain on one side of the upper body, regardless of whether the pain is nociceptive (from tissue injury), neuropathic (from nerve damage), or a combination of both.[3] This procedure is performed on the brain hemisphere opposite to the site of pain and primarily targets the spinothalamic tract in the midbrain.[3][4]

After local anesthesia administration, MRI and CT imaging are used in conjunction with a skull-mounted stereotactic frame to identify the target site in the brain.[3] A small incision is then made in the scalp, and a small hole is drilled into the skull. After an electrode is inserted to reach the target site, stimulation tests are carried out to confirm the exact location of the electrode.[3] Undesirable responses such as tinnitus, limb paresthesia and ipsilateral ocular movement (abnormal eye movements on the same side) may occur if the electrode is inaccurately positioned, requiring further adjustment.[3] Once the correct location is confirmed, the target tract is destroyed by thermocoagulation, a procedure that uses heat to create a small lesion.[3][4]

Spinothalamic tractotomy
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Spinothalamic tractotomy, also known as spinal cordotomy, is primarily used in patients having long-term severe pain localized on one side of the body below shoulders.[5][6] This procedure involves a mechanical or thermal disruption of sensory neurons within the spinothalamic tract, interrupting the transmission of noxious stimuli and temperature signals to the thalamus.[6][7] Notably, the procedure aims to eliminate pain while preserving localized physical sensations and unconscious perceptions of movement and spatial orientation.[6][8][9]

Lumbar myelography featuring the injection of contrast dye with a needle and its resulting visual sharpening under CT imaging

Percutaneous cordotomy is the most well-studied spinal cordotomy, which begins by injecting a “contrast dye” into the fluid-filled space surrounding the spinal cord.[6] This allows for visualization of the spinal cord within the neck region. Alongside local anesthetic administration, the surgeon places a spinal needle right against the spinal cord under CT imaging, allowing for guided deployment of the radio-frequency electrode into the spinal cord to the targeted site.[6] To ensure accuracy, low-frequency electrical stimulation is used to confirm the electrode is safely away from the corticospinal tracts.[6] Once positioned, the tip is heated to create a targeted lesion.[6]

An exception is made for patients experiencing pain on both sides of the body.[6] In these cases, an open cordotomy (a more invasive procedure directly accessing the spinal cord under general anesthesia) in the chest region is used to avoid respiratory complications.[6]

Movement disorders

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Pallidothalamic tractotomy
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A patient wearing an ultrasound transducer is positioned in a MRI scanner for incisionless MRgFUS lesioning

Pallidothalamic tractotomy, also called campotomy, is a neurosurgical procedure typically used to treat movement disorders, particularly in patients with Parkinson’s disease who present motor symptoms such as tremor, rigidity and bradykinesia.[10] The procedure targets the pallidothalamic tracts, which are myelinated fiber pathways connecting the globus pallidus internus to the thalamus. These tracts are important components of the basal ganglia-thalamocortical circuits that regulate motor control.

Pallidothalamic tractotomy has been performed using magnetic resonance-guided focused ultrasound (MRgFUS), a non-invasive procedure that eliminates the need for incisions, burr holes, and electrode insertions.[10] Several low-power sonications are first applied to heat the target below the threshold for coagulation necrosis (permanent tissue damage).[10] After radiological confirmation of the location, a series of high-power sonications are applied, gradually increasing the temperature at the target site to produce precise lesioning of the palliothalamic tract.[10] This approach has been proven to be a safe and effective alternative to pallidotomy, a traditional invasive method for treating movement disorders.[11]

Psychiatric illnesses

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Subcaudate tractotomy
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Subcaudate tractotomy, modernly performed as stereotactic subcaudate tractotomy, is a neurosurgical procedure for treatment-resistant psychiatric disorders.[12] It is reserved as a last-resort measure for patients with severe, persistent psychiatric illness when both pharmacological treatments (like antidepressants) and electroconvulsive therapy (a controlled, electric shock-driven seizure at the brain) prove ineffective.[12][13]

Beta decay converts a neutron into a proton, emitting a high-speed electron (beta radiation)

The neurosurgical procedure is conducted on the frontal lobes, a section of the brain directly behind the forehead responsible for emotional and behavioral control.[12][14] It targets the limbic system, mainly responsible for emotion processing,[15] to regulate clinically abnormal emotional expressions.[12]

After applying general anesthesia, the procedure begins with two forehead incisions. They allow subsequent drilling of small openings (burr-holes) in the front of the skull,[16] which are positioned high enough to avoid the hollow spaces in the lower forehead.[12][17] Then, a stereotactic instrument (such as the McCaul instrument) is complemented by X-ray imaging to establish reference points and validate the surgical path direction.[12][18] Afterwards, the surgeon slides a thin tube into the brain, allowing the placement of yttrium-90.[12] These radioactive rods produce lesions by beta-radiation (emission of high-energy electrons from radioactive atoms),[19] eventually destroying a specific area of the surrounding tissue.[12]

Respiratory system

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Traumatic lung injuries

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Pulmonary tractotomy
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Pulmonary tractotomy is a surgical technique utilized in patients with severe lung injuries, such as penetrating and blunt through-and-through wounds in the lung that do not involve major blood vessels and airways at the hilum.[20] Simply oversewing the entrance and exit wounds for these types of injuries may lead to continued bleeding in the lung, hematoma and alveolar-bronchiolar/venous fistula (abnormal connections between airways and veins).[21] In some cases, it may also result in systemic air embolism, a life-threatening condition in which air bubbles enter the bloodstream and obstruct blood flow.[21]  

A linear cutter stapler used for cutting lung tissues and creating a staple line

In the past, patients with such injuries were usually treated with lobectomy, a procedure that removes a lung lobe but carries significant risks and high complication rates.[21] Pulmonary tractotomy offers a safer alternative by avoiding the removal of lung sections, preserving as much healthy lung tissues as possible.[21]

In practice, a linear cutter stapler is first placed through the entrance and exit points of the wound. When activated, it cuts open the tract and simultaneously creates a staple line.[22][23] The exposed tract is then carefully inspected for any bleeding sites and air leaks, which are ligated using absorbable sutures.[22][23] Finally, the tract is left open rather than closed to reduce the risk of postoperative complications.[21]

Risks and complications

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Complications of tractotomy mainly result from unintended injury to adjacent neural pathways during the surgical procedure. Because these tracts mediate different sensory, motor, and autonomic functions, injuries acquired may produce deficits across multiple functions. Damage to sensory tracts can produce abnormal or reduced sensation, including paresthesias, dysesthesias, or hypoesthesia,[1][24][25] while injury to motor pathways may result in impaired coordination or varying degrees of muscle weakness.[26] Disruption of autonomic fibers has been associated with bladder dysfunction and respiratory difficulties.[6][27] In addition, several reports described cognitive or psychoemotional effects, such as confusion, lethargy, or mood disturbance.[25][28]

In pulmonary tractotomy, postoperative complications more commonly relate to infection. Empyema and lung abscess formation are among the most significant concerns following the procedure.[29]

Recovery

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Open tractotomy

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As the most invasive procedure, the recovery timespan is usually the longest.[26] Although pain relief is often immediate, relapse may occur, and motor coordination failures often occur in the early postoperative period.[26] Temporary deficits in motor movements require daily coordination and gait testing (balance and movement checks) with resolution before discharge.[26]

Stereotactic tractotomy

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The approach, featuring patient confirmation on sensory effects in real time to prevent over-lesioning, implies that patient cooperation during surgery directly predicts better post-operative outcomes.[30] Patients may experience neurological disturbances in the immediate post-operative period, including cranial nerve deficits like gaze palsy and sensory disturbances like dysesthesia and analgesia (loss of pain sensation), which gradually diminish during follow-up.[30]

Percutaneous tractotomy

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Considered minimally invasive, this procedure requires patients to stay in the intensive care unit overnight for serial neurologic examinations (repeated neurological assessments at regular intervals).[1] Temporary motor deficits are seldom observed,[26] and patients are typically discharged home the next day.[1] However, the smaller lesion is reported to be associated with a higher rate of pain recurrence compared to open surgery.[26]

History

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Tractotomy evolved throughout the 20th century from open surgical procedures to increasingly precise, less invasive techniques.

Earlier techniques tackling pain exposed nerve tracts directly. Open cordotomy, first performed by William Gibson Spiller and Edward Martin in 1912, established the principle of cutting pain-conducting pathways.[6] Building on this, Olof Sjöqvist and Achille Mario Dogliotti respectively introduced trigeminal and mesencephalic tractotomy in 1938, though all three procedures carried risks of post-operative complications like loss of pain sensation, partial vision loss, and other neurological injuries.[3][6][31]

By mid-century, the technical focus switched to stereotactic procedures. Ernest Adolf Spiegel and Henry T. Wycis introduced stereotactic mesencephalic tractotomy for pain control in 1947, and the procedure was usually complemented by X-ray imaging.[3] Exploring deeper into subthalamic structures, the duo eventually developed campotomy.[32] Stereotactic trigeminal tractotomy evolved in parallel, as Benjamin L. Crue Jr. and his associates pioneered radiofrequency on the spinal trigeminal tract of an awake patient in 1967, grounding stereotactic trigeminal nucleotractotomy.[2] Gabriel Mazars subsequently refined stereotactic mesencephalic tractotomy, improving precision and significantly reducing morbidity.[3] Even for psychiatric indications, stereotactic surgery became the standard. In 1964, Geoffrey Knight introduced stereotactic subcaudate tractotomy to deal with emotional disorders.[33] Using radiation to disrupt neural pathways, the technique was advanced for its time, and is still used in limited cases today.[33]

To the later stage of the 20th century, percutaneous approaches became more popular due to its minimal invasiveness. John (Sean) Mullan and his colleagues’ development of percutaneous cordotomy under fluoroscopic guidance in 1967 ushered in a new era of local anesthesia in pain management.[6] Around the same period, John L. Fox and later Yücel Kanpolat progressively refined percutaneous trigeminal tractotomy and nucleotractotomy respectively through freehand and CT-guided methods, establishing the high effectiveness yet low complication risks of the technique.[2]

Pulmonary tractotomy followed a completely different trajectory, introduced by Matthew J. Wall Jr. et al. in 1994 for deep penetrating injuries of the lung.[34] The technique has acquired great reported excellence.[34]

References

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  1. 1 2 3 4 5 6 Rao, Abigail; Raslan, Ahmed M. (2019), "Trigeminal Tractotomy-Nucleotomy", Functional Neurosurgery and Neuromodulation, Elsevier, pp. 85–88, doi:10.1016/B978-0-323-48569-2.00012-4, ISBN 978-0-323-48569-2, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  2. 1 2 3 4 5 6 7 8 Teixeira, M. J.; Fonoff, E. T. (2009), "Technique of Trigeminal Nucleotractotomy", Textbook of Stereotactic and Functional Neurosurgery, Springer, Berlin, Heidelberg, pp. 2097–2123, doi:10.1007/978-3-540-69960-6_124, ISBN 978-3-540-69960-6, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  3. 1 2 3 4 5 6 7 8 9 Fountas, Kostas N.; Kapsalaki, Eftychia Z.; Smith, Joseph R. (2012), "Mesencephalic Tractotomy and Anterolateral Cordotomy for Intractable Pain", Schmidek and Sweet Operative Neurosurgical Techniques, Elsevier, pp. 1443–1453, doi:10.1016/b978-1-4160-6839-6.10127-3, ISBN 978-1-4160-6839-6, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  4. 1 2 "Stereotactic Mesencephalotomy – Vancouver Functional Neurosurgery". drhoney.org. Retrieved 2026-04-08.
  5. ↑ Lampl, Y. (2012), "Pain", Encyclopedia of Human Behavior, Elsevier, pp. 1–13, doi:10.1016/B978-0-12-375000-6.00264-0, ISBN 978-0-08-096180-4, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 Javed, Saba; Viswanathan, Ashwin; Abdi, Salahadin (June 2020). "Cordotomy for Intractable Cancer Pain: A Narrative Review". Pain Physician. 23 (3): 283–292. ISSN 2150-1149. PMID 32517394.
  7. ↑ Lawson, Sally N; Fang, Xin; Djouhri, Laiche (2019-10-01). "Nociceptor subtypes and their incidence in rat lumbar dorsal root ganglia (DRGs): focussing on C-polymodal nociceptors, Aβ-nociceptors, moderate pressure receptors and their receptive field depths". Current Opinion in Physiology. Physiology of Pain. 11: 125–146. doi:10.1016/j.cophys.2019.10.005. ISSN 2468-8673.
  8. ↑ Dharani, Krishnagopal (2015), "The Perceptual Neurons", The Biology of Thought, Elsevier, pp. 93–108, doi:10.1016/B978-0-12-800900-0.00005-1, ISBN 978-0-12-800900-0, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  9. ↑ Brumagne, Simon; Dolan, Patricia; Pickar, Joel G. (2013), "What is the relation between proprioception and low back pain?", Spinal Control, Elsevier, pp. 219–230, doi:10.1016/B978-0-7020-4356-7.00019-7, ISBN 978-0-7020-4356-7, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  10. 1 2 3 4 Metta, Vinod; Benamer, Hani Taha Sherif; Kapsas, Georgios; Mridula, Rukmini; Alugolu, Rajesh; Hussain, Hasna; Nalarakettil, Afsal; Sai, Sampath Kumar Natuva; Elmahdy, Mohamed; Borgohain, Rupam; Chaudhuri, Kallol Ray (2025-10-31). "MRI-Guided Focused Ultrasound in Parkinson's Disease and Essential Tremor: Incisionless but Invasive. A Narrative Review". Journal of Movement Disorders. 18 (4): 289–303. doi:10.14802/jmd.25042. ISSN 2005-940X. PMC 12580729. PMID 40468908.
  11. ↑ Guridi, Jorge; Gonzalez-Quarante, Lain Hermes (March 2021). "Revisiting Forel Field Surgery". World Neurosurgery. 147: 11–22. doi:10.1016/j.wneu.2020.11.143.
  12. 1 2 3 4 5 6 7 8 Bridges, P. K.; Bartlett, J. R.; Hale, A. S.; Poynton, A. M.; Malizia, A. L.; Hodgkiss, A. D. (November 1994). "Psychosurgery: Stereotactic Subcaudate Tractotomy: An Indispensable Treatment". The British Journal of Psychiatry. 165 (5): 599–611. doi:10.1192/bjp.165.5.599. ISSN 0007-1250.
  13. ↑ Salik, Irim; Marwaha, Raman (2026), "Electroconvulsive Therapy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30855854, retrieved 2026-04-08
  14. ↑ "Brain Map Frontal Lobes". Queensland Health. 2022-07-12. Retrieved 2026-04-08.
  15. ↑ Torrico, Tyler J.; Abdijadid, Sara (2026), "Neuroanatomy, Limbic System", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30860726, retrieved 2026-04-08
  16. ↑ "burr hole". www.cancer.gov. 2011-02-02. Retrieved 2026-04-08.
  17. ↑ "paranasal sinus". www.cancer.gov. 2011-02-02. Retrieved 2026-04-08.
  18. ↑ "Stereotactic Neurosurgical Procedures". Taylor Family Department of Neurosurgery. Retrieved 2026-04-08.
  19. ↑ Brusseau, M.L.; Chorover, J. (2019), "Chemical Processes Affecting Contaminant Transport and Fate", Environmental and Pollution Science, Elsevier, pp. 113–130, doi:10.1016/B978-0-12-814719-1.00008-2, ISBN 978-0-12-814719-1, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  20. ↑ Roberts, Derek J.; Bobrovitz, Niklas; Zygun, David A.; Ball, Chad G.; Kirkpatrick, Andrew W.; Faris, Peter D.; Parry, Neil; Nicol, Andrew J.; Navsaria, Pradeep H.; Moore, Ernest E.; Leppäniemi, Ari K.; Inaba, Kenji; Fabian, Timothy C.; D’Amours, Scott; Brohi, Karim (October 2015). "Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: A content analysis and expert appropriateness rating study". Journal of Trauma and Acute Care Surgery. 79 (4): 568–579. doi:10.1097/TA.0000000000000821. ISSN 2163-0755.
  21. 1 2 3 4 5 Wall, Matthew J.; Tsai, Peter I.; Mattox, Kenneth L. (2012), "Pulmonary Tractotomy", Encyclopedia of Intensive Care Medicine, Springer, Berlin, Heidelberg, pp. 1917–1918, doi:10.1007/978-3-642-00418-6_507, ISBN 978-3-642-00418-6, retrieved 2026-04-08{{citation}}: CS1 maint: work parameter with ISBN (link)
  22. 1 2 Petrone, Patrizio; Asensio, Juan A (2009). "Surgical management of penetrating pulmonary injuries". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 17 (1): 8. doi:10.1186/1757-7241-17-8. ISSN 1757-7241. PMC 2650680. PMID 19236703.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  23. 1 2 Garcia, Alberto; Millan, Mauricio; Ordoñez, Carlos Alberto; Burbano, Daniela; Parra, Michael W; Caicedo, Yaset; González-Hadad, Adolfo; Herrera, Mario Alain; Pino, Luis Fernando; Rodríguez-Holguín, Fernando; Salcedo, Alexander; Franco, Maria Josefa; Ferrada, Ricardo; Puyana, Juan Carlos (2021-05-19). "Damage control surgery in lung trauma". Colombia Medica. 52 (2): e4044683. doi:10.25100/cm.v52i2.4683. ISSN 1657-9534. PMC 8216053. PMID 34188322.
  24. ↑ Prado, Sarah Grunberg Almeida; Mazer, Lígia Del’ Agnolo; de Aguiar, Paulo Henrique Pires; de Oliveira, Silvia (2025-11-02). "Mesencephalotomy for the treatment of facial cancer pain: a systematic review of the literature". Pain Management. 15 (11): 877–884. doi:10.1080/17581869.2025.2555800. ISSN 1758-1869. PMC 12562721. PMID 40910717.
  25. 1 2 Ismail, Arif; Fahmi, Achmad; Turchan, Agus; Utomo, Budi; Fauzi, Asra Al; Subianto, Heri; Wisnawa, I Wayan Weda; Brilliantika, Surya Pratama (2024-03-29). "GPi pallidotomy versus pallidothalamic tractotomy forel h-1 in Parkinson's disease: a systematic review in outcome and complication". Bali Medical Journal. 13 (2): 817–824. doi:10.15562/bmj.v13i2.5118. ISSN 2302-2914.
  26. 1 2 3 4 5 6 Anisimov, Egor Dmitrievich; Rzaev, Jamil A.; Moysak, Galina I.; Dmitriev, Alexander B.; Duff, Irina E.; Slavin, Konstantin V. (2023). "Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review". Stereotactic and Functional Neurosurgery. 101 (6): 387–394. doi:10.1159/000534488. ISSN 1011-6125.
  27. ↑ Allam, Anthony K.; Larkin, Michael Benjamin; Patel, Ishan A.; Hasen, Mohammed; Mears, David; Dougherty, Patrick; Viswanathan, Ashwin (2025). "The human spinothalamic tract: lessons from cordotomy". Brain Communications. 7 (3): fcaf237. doi:10.1093/braincomms/fcaf237. ISSN 2632-1297. PMC 12198438. PMID 40574969.{{cite journal}}: CS1 maint: article number as page number (link)
  28. ↑ Bakar, Bulent; Cetin, Cansel; Oppong, Jonathan; Erdogan, Ahmet Melih (2019-03-01). "Current Ablation Type Surgical Treatment Modalities in Treatment-Resistant Major Depression: Review of The Recent Major Surgical Series". Journal of Basic and Clinical Health Sciences. 3 (1): 1–8. doi:10.30621/jbachs.2019.452. ISSN 2564-7288.
  29. ↑ Koga, Hiroyasu; Watanabe, Katsuya; Saito, Aya (2025-05-26). "Thoracoscopic repair of penetrating lung trauma with pulmonary tractotomy: a case report". General Thoracic and Cardiovascular Surgery Cases. 4 (1): 25. doi:10.1186/s44215-025-00209-2. ISSN 2731-6203. PMC 12107820. PMID 40420151.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  30. 1 2 Régis, Jean; Souissi, Ghassen; Balossier, Anne (2025-07-31). "Stereotactic Spinothalamic Mesencephalic Tractotomy for the Treatment of Cancer Pain in the Neuromodulation Era: Advocacy for the Renaissance of a Forgotten Surgery". Stereotactic and Functional Neurosurgery. 103 (6): 533–542. doi:10.1159/000547640. ISSN 1011-6125.
  31. ↑ Hamby, Wallace B. (1948-07-01). "TRIGEMINAL TRACTOTOMY: Observations on Forty-Eight Cases". Archives of Surgery. 57 (1): 171. doi:10.1001/archsurg.1948.01240020174015. ISSN 0272-5533.
  32. ↑ Blomstedt, Patric; Sandvik, Ulrika; Fytagoridis, Anders; Tisch, Stephen (June 2009). "THE POSTERIOR SUBTHALAMIC AREA IN THE TREATMENT OF MOVEMENT DISORDERS: PAST, PRESENT, AND FUTURE". Neurosurgery. 64 (6): 1029–1042. doi:10.1227/01.NEU.0000345643.69486.BC. ISSN 0148-396X.
  33. 1 2 Heller, A Chris; Amar, Arun P.; Liu, Charles Y.; Apuzzo, Michael L.J. (October 2006). "Surgery of the Mind and Mood: A Mosaic of Issues in Time and Evolution". Neurosurgery. 59 (4): 720–739. doi:10.1227/01.NEU.0000240227.72514.27. ISSN 0148-396X.
  34. 1 2 Kamiyoshihara, Mitsuhiro; Ibe, Takashi; Takeyoshi, Izumi (2007-05-01). "A middle lobe tractotomy of the lung for a stab injury: report of a survival case". General Thoracic and Cardiovascular Surgery. 55 (5): 193–196. doi:10.1007/s11748-007-0102-1. ISSN 1863-6713.
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