CPT® Code 61480

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Mesencephalic tractotomy, also known as pedunculotomy, is a neurosurgical procedure that involves the division or cutting of a specific nerve tract within the brain, particularly targeting the midbrain region. This intervention is primarily indicated for the management of intractable pain, especially pain that arises from conditions such as head and neck cancer, which is classified as nociceptive pain. The procedure aims to alleviate unilateral intractable pain by disrupting the spinothalamic tract, a critical pathway responsible for transmitting pain signals from the spinal cord to the brain. Traditionally, open tractotomy techniques have been associated with significant morbidity, including complications such as deafness, gaze palsy, and dysaesthesia. Due to these risks, less invasive alternatives, such as stereotactic tractotomy, have gained preference in clinical practice. The mesencephalon, or midbrain, is accessed through a suboccipital craniotomy, which requires careful positioning of the patient and meticulous surgical technique to ensure optimal exposure and minimize potential complications.