Limited midline myelotomy for visceral pain M. Benjamin Larkin, MD, PharmD, Robert Y. North, MD, PhD, Aditya Vedantam, MD, and Ashwin Viswanathan, MD Department of Neurosurgery, Baylor College of Medicine, Houston, Texas The traditional commissural myelotomy consists of a sagittal cut in the midline and was originally described by Greenfield and performed by Armour in 1926. Today, myelotomy refers to the selective disruption of the ascending visceral pain pathway. The success of the procedure is incumbent on the correct identification of the midline. Limited midline open myelotomy for the treatment of medically intractable abdominal or pelvic visceral cancer pain, with the aid of somatosensory evoked potentials to identify midline, offers patients superior pain relief over similar percutaneous techniques. Multicenter registries are needed to better elucidate the best surgical technique for this procedure.