Stereotactic Ablative Procedures for Pain Relief

Intracranial stereotactic procedures in the central nervous system for the treatment of medically refractory chronic pain have evolved over the years. Neuroablative lesions have become a rare treatment for chronic pain, primarily because of the advent of more effective pharmacotherapy and intrathecal drug delivery. Lesion generation has the advantage of being less costly and having none of the hardware-related side effects of deep brain stimulation but the disadvantage of not being modifiable or reversible when the lesion has been generated. Although neuroablative procedures typically result in short-lived pain relief and the possibility of deafferentation pain, these procedures are still useful in certain clinical settings. The indications, methods employed, and outcome for these procedures are covered in this article.

Thalamotomy - mesencephalic tractotomy - chronic pain

REFERENCES

• 1 Christensen B N, Perl E R. Spinal neurons specifically excited by noxious or thermal stimuli: marginal zone of the dorsal horn.  J Neurophysiol. 1970;  33 293-307
• 2 Dubner R, Kenshalo Jr D R, Maixner W et al.. The correlation of monkey medullary dorsal horn neuronal activity and the perceived intensity of noxious heat stimuli.  J Neurophysiol. 1989;  62 450-457
• 3 Maixner W, Dubner R, Kenshalo Jr D R, Bushnell M C, Oliveras J L. Responses of monkey medullary dorsal horn neurons during the detection of noxious heat stimuli.  J Neurophysiol. 1989;  62 437-449
• 4 Ammons W S, Girardot M N, Foreman R D. T2-T5 spinothalamic neurons projecting to medial thalamus with viscerosomatic input.  J Neurophysiol. 1985;  54 73-89
• 5 Menetrey D, de Pommery J, Besson J M. Electrophysiological characteristics of lumbar spinal cord neurons backfired from lateral reticular nucleus in the rat.  J Neurophysiol. 1984;  52 595-611
• 6 Willis W The Origin and Destination of Pathways Involved in Pain Transmission. New York; Churchill Livingstone 1989
• 7 Craig A D, Bushnell M C, Zhang E T, Blomqvist A. A thalamic nucleus specific for pain and temperature sensation.  Nature. 1994;  372 770-773
• 8 Blomqvist A, Zhang E T, Craig A D. Cytoarchitectonic and immunohistochemical characterization of a specific pain and temperature relay, the posterior portion of the ventral medial nucleus, in the human thalamus.  Brain. 2000;  123 601-619
• 9 Dostrovsky J O, Craig A D. Cooling-specific spinothalamic neurons in the monkey.  J Neurophysiol. 1996;  76 3656-3665
• 10 Davis K D, Lozano R M, Manduch M, Tasker R R, Kiss Z H, Dostrovsky J O. Thalamic relay site for cold perception in humans.  J Neurophysiol. 1999;  81 1970-1973
• 11 Craig A. Supraspinal projections of lamina I neurons. In: Besson J-M Forebrain Processing of Pain. Paris; Eurotext John Libbey 1995: 13-25
• 12 Schnitzler A, Ploner M. Neurophysiology and functional neuroanatomy of pain perception.  J Clin Neurophysiol. 2000;  17 592-603
• 13 Hassler R Architectonic Organization of the Thalamic Nuclei. New York; Thieme-Stratton 1982
• 14 Hardy T L, Bertrand G, Thompson C J. Organization and topography of sensory responses in the internal capsule and nucleus ventralis caudalis found during stereotactic surgery.  Appl Neurophysiol. 1980;  42 335-351
• 15 Hardy T L, Bertrand G, Thompson C J. Position and organization of thalamic cellular activity during diencephalic recording. I. Pressure-evoked activity.  Appl Neurophysiol. 1980;  43 18-27
• 16 Davis K D, Tasker R R, Kiss Z H, Hutchison W D, Dostrovsky J O. Visceral pain evoked by thalamic microstimulation in humans.  Neuroreport. 1995;  6 369-374
• 17 Ohye C. Stereotactic treatment of central pain.  Stereotact Funct Neurosurg. 1998;  70 71-76
• 18 Lenz F A, Gracely R H, Romanoski A J, Hope E J, Rowland L H, Dougherty P M. Stimulation in the human somatosensory thalamus can reproduce both the affective and sensory dimensions of previously experienced pain.  Nat Med. 1995;  1 910-915
• 19 Burton H, Jones E G. The posterior thalamic region and its cortical projection in New World and Old World monkeys.  J Comp Neurol. 1976;  168 249-301
• 20 Coghill R C, Talbot J D, Evans A C, Hirabuki N, Nakamura H, Yoshiya I. Distributed processing of pain and vibration by the human brain.  J Neurosci. 1994;  14 4095-4108
• 21 Oshiro Y, Fuijita N, Tanaka H et al.. Functional mapping of pain-related activation with echo-planar MRI: significance of the SII-insular region.  Neuroreport. 1998;  9 2285-2289
• 22 Spiller W, Martin E. The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord.  JAMA. 1912;  58 1489-1490
• 23 Gybels J, Tasker R. Central Neurosurgery. 4th ed. Philadelphia; WB Saunders 1999
• 24 Spiegel E, Wycis H. Pallidothalamotomy in chorea. Presented at the Philadelphia Neurological Society April 22, 1949
• 25 Gybels J, Kupers R, Nuttin B. Therapeutic stereotactic procedures on the thalamus for pain.  Acta Neurochir (Wien). 1993;  124 19-22
• 26 IASP .Task Force on Taxonomy: Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle; IASP Press 1994
• 27 Boivie J Central Pain. Edinburgh; Churchill Livingstone 1994
• 28 Tasker R R. Thalamotomy.  Neurosurg Clin N Am. 1990;  1 841-864
• 29 Schaltenbrand G, Wahren W. Atlas for Stereotaxy of the Human Brain. Architectonic Organization of the Thalamic Nuclei by Rolf Hassler: with an Accompanying Guide. 2nd ed. Stuttgart; G Thieme 1977
• 30 Hutchison W, Lozano A. Microelectrode recordings in movement disorder surgery. In: Lozano A Movement Disorder Surgery. Vol 15 Basel; Karger 2000: 103-117
• 31 Hécaen H, Talairach J, David M et al.. Coagulations limitées du thalamus dans les algies du syndrome thalamique.  Rev Neurol (Paris). 1949;  81 917-931
• 32 Mark V, Ervin F. Role of thalamotomy in the treatment of chronic severe pain.  Postgrad Med. 1965;  37 563-571
• 33 Mark V, Ervin F, Yakolev P. Correlation of pain relief, sensory loss, and anatomical lesion sites in pain patients treated by stereotactic thalamotomy.  Trans Am Neurol Assoc. 1961;  86 86-90
• 34 Gorecki J, Hirayama T, Dostrovsky J O, Tasker R R, Lenz F A. Thalamic stimulation and recording in patients with deafferentation and central pain.  Stereotact Funct Neurosurg. 1989;  52 219-226
• 35 Davis K D, Kiss Z H, Tasker R R, Dostrovsky J O. Thalamic stimulation-evoked sensations in chronic pain patients and in nonpain (movement disorder) patients.  J Neurophysiol. 1996;  75 1026-1037
• 36 Roth C, Jeanmonod D, Magnin M, Morel A, Achermann P. Effects of medial thalamotomy and pallido-thalamic tractotomy on sleep and waking EEG in pain and Parkinsonian patients.  Clin Neurophysiol. 2000;  111 1266-1275
• 37 Davis K D, Lozano A M, Tasker R R et al.. Brain targets for pain control.  Stereotact Funct Neurosurg. 1998;  71 173-179
• 38 Niizuma H, Kwak R, Ikeda S, Ohyama H, Suzuki J, Saso S. Follow-up results of centromedian thalamotomy for central pain.  Appl Neurophysiol. 1982;  45 324-325
• 39 Young R F, Jacques D S, Rand R W, Copcutt B C, Vermeulen S S, Posewitz A E. Technique of stereotactic medial thalamotomy with the Leksell Gamma Knife for treatment of chronic pain.  Neurol Res. 1995;  17 59-65
• 40 Rezai A R, Lozano A M, Crawley A P et al.. Thalamic stimulation and functional magnetic resonance imaging: localization of cortical and subcortical activation with implanted electrodes. Technical note.  J Neurosurg. 1999;  90 583-590
• 41 Jeanmonod D, Magnin M, Morel A. Thalamus and neurogenic pain: physiological, anatomical and clinical data.  Neuroreport. 1993;  4 475-478
• 42 Frank F, Fabrizi A P, Gaist G, Weigel K, Mundinger F. Stereotactic mesencephalotomy versus multiple thalamotomies in the treatment of chronic cancer pain syndromes.  Appl Neurophysiol. 1987;  50 314-318
• 43 Tasker R. Stereotactic Surgery. Edinburgh; Churchill Livingstone 1984
• 44 Bosch D A. Stereotactic rostral mesencephalotomy in cancer pain and deafferentation pain. A series of 40 cases with follow-up results.  J Neurosurg. 1991;  75 747-751
• 45 Spiegel E, Wycis H. Mesencephalotomy in treatment of “intractable” facial pain.  AMA Arch Neurol Psychiatry. 1953;  69 1-13
• 46 Gybels J, Sweet W. Neurosurgical Treatment of Persistent Pain. Vol 11. Basel; Karger 1989
• 47 Nashold Jr B S, Wilson W P, Slaughter D G. Sensations evoked by stimulation in the midbrain of man.  J Neurosurg. 1969;  30 14-24
• 48 Frank F, Fabrizi A P, Gaist G. Stereotactic mesencephalic tractotomy in the treatment of chronic cancer pain.  Acta Neurochir (Wien). 1989;  99 38-40
• 49 Shieff C, Nashold Jr B S. Stereotactic mesencephalic tractotomy for thalamic pain.  Neurol Res. 1987;  9 101-104
• 50 Hitchcock E R. Stereotaxic pontine spinothalamic tractotomy.  J Neurosurg. 1973;  39 746-752
• 51 Hitchcock E, Kim M C, Sotelo M. Further experience in stereotactic pontine tractotomy.  Appl Neurophysiol. 1985;  48 242-246
• 52 Lindquist C, Kihlstrom L, Hellstrand E. Functional neurosurgery-a future for the gamma knife?.  Stereotact Funct Neurosurg. 1991;  57 72-81
• 53 Hitchcock E R, Teixeira M J. A comparison of results from center-median and basal thalamotomies for pain.  Surg Neurol. 1981;  15 341-351
• 54 Tasker R R. The recurrence of pain after neurosurgical procedures.  Qual Life Res. 1994;  3 S43-S49
• 55 Hitchcock E, Teixeira M J. Pontine stereotactic surgery and facial nociception.  Neurol Res. 1987;  9 113-117
• 56 Lockard B I, Kempe L G. Position sense in the lateral funiculus?.  Neurol Res. 1988;  10 81-86
• 57 Barbera J, Barcia-Salorio J L, Broseta J. Stereotaxic pontine spinothalamic tractotomy.  Surg Neurol. 1979;  11 111-114
• 58 Winter A. Depression and intractable pain treated by modified prefrontal lobotomy.  J Med Soc N J. 1972;  69 757-759
• 59 Fraioli B, Guidetti B. Effects of stereotactic lesions of the pulvinar and lateralis posterior nucleus on intractable pain and dyskinetic syndromes of man.  Appl Neurophysiol. 1975;  38 23-30
• 60 Martin-Rodriguez J G, Obrador S. Evaluation of stereotaxic pulvinar lesions.  Confin Neurol. 1975;  37 56-62
• 61 Yoshii N, Fukuda S. Several clinical aspects of thalamic pulvinotomy.  Appl Neurophysiol. 1976;  39 162-164
• 62 Fairman D. Stereotactic hypothalamotomy for the alleviation of pain in malignant tumors.  J Surg Oncol. 1973;  5 79-84
• 63 Sano K, Sekino H, Hashimoto I, Amano K, Sugiyama H. Posteromedial hypothalamotomy in the treatment of tractable pain.  Confin Neurol. 1975;  37 285-290
• 64 Moricca G, Arcuri E, Moricca P. Neuroadenolysis of the pituitary.  Acta Anaesthesiol Belg. 1981;  32 87-99
• 65 Whittle I R, Jenkinson J L. CT-guided stereotactic antero-medial pulvinotomy and centromedian-parafascicular thalamotomy for intractable malignant pain.  Br J Neurosurg. 1995;  9 195-200
• 66 Hariz M I, Bergenheim A T. Thalamic stereotaxis for chronic pain: ablative lesion or stimulation?.  Stereotact Funct Neurosurg. 1995;  64 47-55