Thalamic Stereotaxis for Chronic Pain: Ablative Lesion or Stimulation?

Abstract

Twenty-five patients underwent 33 stereotactic procedures on the thalamus for the treatment of persistent pain of benign or malignant origin. There were 19 ablative and 14 stimulation procedures. The thalamic targets were the centrum medianum (CM), the pulvinar, the nucleus ventralis posteromedialis and/or the nucleus ventralis posterolater-alis. Ablative surgery was successful in 52.6% of the procedures, and chronic stimulation in 66%. Stimulation in the ventroposterior group of the thalamus was most effective for peripheral deafferentation pain while ablative stereotaxis on the CM may be more appropriate for patients with central pain or cancer pain.

Center Median-Parafascicular Complex and Pain Control

“…According to the Schaltenbrand-Wahren atlas [126], the coordinates of the Weigel/Krauss target were directed more to Pf than to CM. When Hariz and Bergenheim [7] compared the results of lesioning versus DBS of the CM, they found ablative surgery to be more effective for central pain, while DBS was better for deafferentation pain. This is somewhat in contrast to the findings of Niizuma et al [127].…”

“…Neurosurgical procedures still play an important role in the treatment of medically refractory neuropathic pain [7][8][9]. Both, the neospinothalamic and the paleospinothalamic relays have been used as targets for ablative surgery in the early years of functional stereotactic neurosurgery [10,11].…”

Stereotactic bilateral anterior cingulotomy for intractable pain

“…[1][2][3] Neuroablative procedures targeting a variety of brain sites have long been performed by neurosurgeons to alleviate the suffering of patients with intractable pain. Destructive lesions placed in the frontal lobe, postcentral gyrus, thalamus [4][5][6][7] and components of the limbic system, particularly the cingulate gyrus [8][9][10][11][12][13] have been reported to be effective to varying degrees. Unfortunately, the usefulness of these procedures is limited by cardiopulmonary risks and the need for general anesthesia.…”

Neurosurgical Approaches to Pain Management

“…2 The first structure targeted for neuroablation was the ventral caudal (Vc) nucleus, as defined by Hassler 3 ; however, it was soon recognized that neuroablation of the Vc nucleus was associated with significant deafferentation pain phenomena. 2 The first structure targeted for neuroablation was the ventral caudal (Vc) nucleus, as defined by Hassler 3 ; however, it was soon recognized that neuroablation of the Vc nucleus was associated with significant deafferentation pain phenomena.…”