Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 38-41 ◽  
Author(s):  
Motohiro Hayashi ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Mikhail Chernov ◽  
Yuichi Takasu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Gamma Knife ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain ◽  
Fine Print

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Chlorpromazine in Thalamic Pain Syndrome

Neurology ◽  
1956 ◽  
Vol 6 (4) ◽  
pp. 302-302 ◽  
Author(s):  
L. H. Margolis ◽  
A. J. Gianascol
Keyword(s):  
Pain Syndrome ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain

Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

2005 ◽  
Vol 102 ◽  
pp. 38-41 ◽  
Author(s):  
Motohiro Hayashi ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Mikhail Chernov ◽  
Yuichi Takasu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Gamma Knife ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain ◽  
Fine Print

Object.Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain.Methods.Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months.Conclusions.An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Gamma Knife surgery targeting the centromedian nucleus of the thalamus for the palliative management of thalamic pain: durable response in stroke-induced thalamic pain syndrome

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 222-228 ◽  
Author(s):  
Marcus F. Keep ◽  
Lois Mastrofrancesco ◽  
Arthur D. Craig ◽  
Lynn S. Ashby
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pain Syndrome ◽  
Physical Contact ◽  
Single Shot ◽  
Resonance Imaging ◽  
Durable Response ◽  
Centromedian Nucleus ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain

✓The authors report the neuroimaging features, treatment planning, and outcome in a case of radiosurgical thalamotomy targeting the centromedian nucleus (CMN) for stroke-induced thalamic pain.A 79-year-old man, with embolic occlusion of the left middle cerebral artery and large hemispheric infarction involving the thalamus, suffered a right hemiplegia and expressive aphasia. One year poststroke, severe right-sided facial, scalp, arm, and trunk pain developed and was exacerbated by any tactile contact. Medical treatment had failed. Medical illness, including mandatory anticoagulation therapy for atrial fibrillation, precluded surgical procedures. Minimally invasive radiosurgery was offered as an alternative. Magnetic resonance imaging and computed tomography were used to localize the left CMN. A single shot of 140 Gy was delivered to the 100% isodose line by using the 4-mm collimator helmet.The patient was evaluated at regular intervals. By 12 weeks posttreatment, he had significant improvements in pain control and his ability to tolerate physical contact during activities of daily living. Magnetic resonance imaging demonstrated baseline encephalomalacia from his prior stroke, and signal changes in the left CMN consistent with gamma irradiation–based thalamotomy. Currently, nearly 7 years after radiosurgery, he continues to enjoy a marked reduction in pain without the need of analgesic medications.Thalamic pain syndrome is generally refractory to conventional treatment. Neurosurgical interventions provide modest benefit and carry associated risks of invasive surgery and anesthesia. The CMN is readily localized with neuroimaging and is an approximate target to reduce the suffering aspect of pain. In this case, radiosurgery was a safe and effective treatment, providing durable symptom control and improved quality of life.

scholarly journals Resolution of symptoms in idiopathic thalamic pain syndrome after implantation of a cervical and thoracic percutaneous spinal cord stimulator

2021 ◽  
Vol 12 ◽  
pp. 50
Author(s):  
Kylie E. Hagerdon ◽  
Lance M. Villeneueve ◽  
Christen M. O’Neal ◽  
Andrew K. Conner
Keyword(s):  
Spinal Cord ◽  
Pain Syndrome ◽  
Thalamic Lesion ◽  
Central Pain ◽  
Case Description ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain

Background: Thalamic pain syndrome is classically described as chronic pain after an infarct of the thalamus. It leads to a decrease in the quality of life, especially for patients with inadequate treatment. Supportive imaging, such as a thalamic lesion or infarct, is widely accepted as necessary to diagnose this condition. Case Description: In this case report, we describe the case of a patient who developed allodynia and hyperesthesia with a hemibody distribution characteristic of thalamic pain syndrome, despite having no clear inciting event or identifiable thalamic lesion. This patient was successfully treated with cervical and thoracic spinal cord stimulation (SCS). Conclusion: We suggest that this patient may have presented with a non-lesional thalamic pain syndrome, supported by the classic hemibody allodynia and hyperesthesia and the response to SCS. Further, we demonstrate that SCS was an effective method to control this central pain disorder.

Outcome After Pituitary Radiosurgery for Thalamic Pain Syndrome

2007 ◽  
Vol 69 (3) ◽  
pp. 852-857 ◽  
Author(s):  
Motohiro Hayashi ◽  
Mikhail F. Chernov ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Kotaro Nakaya ◽  
...  
Keyword(s):  
Pain Syndrome ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain
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