Image-Guided Motor Cortex Stimulation in Patients with Central Pain

Abstract

According to recent clinical data, motor cortex stimulation (MCS) is an alternative treatment for central pain syndromes. We present our minimally invasive technique of image guidance for the placement of the motor cortex-stimulating electrode and assess the clinical usefulness of both neuronavigation and vacuum headrest. Five patients suffering from central pain underwent MCS with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany). The neuronavigation was used for identification of the precentral gyrus and accurate planning of the single burr hole. The exact location was reconfirmed by an intraoperative stimulation test. Postoperative clinical and neuroradiological evaluations were performed in each patient. The navigation system worked properly in all 5 neurosurgical cases. Determination of the placement of stimulating electrode was possible in every case. All patients obtained postoperative pain relief. No surgical complication occurred, and the postoperative course was uneventful in all patients. This preliminary experience may confirm image guidance as a useful tool for the surgery of MCS. Additionally, minimal and safe exposure can be achieved using a single burr hole and vacuum headrest.

Central pain - intraoperative somatosensory - motor cortex stimulation - neuronavigation - thalamic pain

References

• 1 Carroll D, Joint C, Maartens N, Shlugman D, Stein J, Aziz T Z. Motor cortex stimulation for chronic neuropathic pain: A preliminary study of 10 cases.  Pain. 2000;  84 431-437
• 2 Nguyen J P, Lefaucheur J P, Decq P, Uchiyama T, Carpentier A, Fontaine D, Brugieres P, Pollin B, Feve A, Rostaing S, Cesaro P, Keravel Y. Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlation between clinical, electrophysiological and anatomical data.  Pain. 1999;  82 245-251
• 3 Saitoh Y, Shibata M, Hirano S I, Hirata M, Mashimo T, Yoshimine T. Motor cortex stimulation for central and peripheral deafferentation pain.  J Neurosurg. 2000;  92 150-155
• 4 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain.  Acta Neurochir (Wien). 1991;  52 (Suppl) 137-139
• 5 Velasco M, Velasco F, Brito F, Velasco A L, Nguyen J P, Marquez I, Boleaga B, Keravel Y. Motor cortex stimulation in the treatment of deafferentation pain. I. Localization of the motor cortex.  Stereotact Funct Neurosurg. 2002;  79 146-167
• 6 Taylor J, Haughton A M. Determination of the Rolandic and Sylvian fissure.  Trans Acad Ireland. 1990;  18 511-526
• 7 King R B, Schnell G R. Cortical localization and monitoring during cerebral operations.  J Neurosurg. 1987;  67 210-219
• 8 Wood C C, Spencer D D, Allison T, McCarthy G, Williamson P D, Goff W R. Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials.  J Neurosurg. 1988;  68 99-111
• 9 Nguyen J P, Keravel Y, Feve A, Uchiyama T, Cesaro P, Le Guerinel C, Pollin B. Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases.  Acta Neurochir (Wien). 1997;  68 (Suppl) 54-60
• 10 Peyron R, Garcia-Larrea L, Deiber M P, Cinotti L, Convers P, Sindou M, Mauguiere F, Laurent B. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study.  Pain. 1995;  62 275-286
• 11 Rainov N G, Heidecke V. Motor cortex stimulation for neuropathic facial pain.  Neurol Res. 2003;  25 157-161
• 12 Saitoh Y, Shibata M, Hirano S I, Kato A, Kishima H, Hirata M, Yamamoto K, Yoshimine T. Motor cortex stimulation for deafferentation pain.  Neurosurg Focus. 2001;  11 1-5
• 13 Franzini A, Ferroli P, Dones I, Marras C, Broggi G. Chronic motor cortex stimulation for movement disorders: a promising perspective.  Neurol Res. 2003;  25 123-126
• 14 Gumprecht H K, Widenka D C, Lumenta C B. BrainLab VectorVision neuronavigation system: technology and clinical experiences in 131 cases.  Neurosurgery. 1999;  44 97-105
• 15 Tirakotai W, Sure U, Benes L, Krischek B, Bien S, Bertalanffy H. Image-guided transsylvian, transinsular approach for insular cavernous angiomas.  Neurosurgery. 203;  53 1299-1304
• 16 Alberti O, Riegel T, Hellwig D, Bertalanffy H. Frameless navigation and endoscopy.  J Neurosurg. 2001;  95 541-543
• 17 Hellwig D, Bauer B L, Schulte D M, Gatscher S, Riegel T, Bertalanffy H. Neuroendoscopic treatment for colloid cysts of the third ventricle: The experience of a decade.  Neurosurgery. 2003;  52 525-532
• 18 Tirakotai W, Riegel T, Sure U, Bozinov O, Hellwig D, Bertalanffy H. Clinical application of neuro-navigation in a series of single burr-hole procedures.  Zentralbl Neurochir. 2004;  65 1-8
• 19 Golfinos J G, Fitzpatrick B C, Smith L R, Spetzler R F. Clinical use of a frameless stereotactic arm: results of 325 cases.  J Neurosurg. 1995;  83 197-205
• 20 Grunert P, Muller-Forell W, Darabi K, Reisch R, Busert C, Hopf N, Perneczky A. Basic principles and clinical applications of neuronavigation and intraoperative computed tomography.  Comput Aided Surg. 1998;  3 166-173
• 21 Reinhardt H F, Trippel M, Westermann B, Horstmann G A, Gratzl O. Computer assisted brain surgery for small lesions in the central sensorimotor region.  Acta Neurochir (Wien). 1996;  138 200-205
• 22 Sure U, Benes L, Riegel T, Schulte D M, Bertalanffy H. Image fusion of skull base neuronavigation - Technical note.  Neurol Med Chir (Tokyo). 2002;  42 458-462
• 23 Rao S M, Binder J R, Hammeke T A, Bandettini P A, Bobholz J A, Frost J A, Myklebust B M, Jacobson R D, Hyde J S. Somatotopic mapping of the human primary motor cortex with functional magnetic resonance imaging.  Neurology. 1995;  45 919-924
• 24 Nguyen J P, Lefaucheur J P, Le Guerinel C, Fontanine D, Nakano N, Sakka L, Eizenbaum J F, Pollin B, Keravel Y. Treatment of central and neuropathic facial pain by chronic stimulation of the motor cortex: value of neuronavigation guidance systems for the localization of the motor cortex.  Neurochirurgie. 2000;  46 483-491
• 25 Brown J A, Barbaro N M. Motor cortex stimulation for central and neuropathic pain: current status.  Pain. 2003;  104 431-435
• 26 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation in patients with thalamic pain.  J Neurosurg. 1993;  78 393-401