Diencephalic Surgery for the Relief of Pain

  • Donlin M. Long
Part of the Contemporary Perspectives in Neurosurgery book series (COPENEU)


Diencephalic surgery for the purpose of relieving pain has a long history and has not been an unqualified success over this time.1,2 There are several reasons for this. Stereotactic surgery, before CT and MRI, depended upon anatomical localization first by intraventricular air study and later by positive contrast. Large ventricles could be confounding, particularly if the third ventricle was wide. The anatomy defined by this technique, while satisfactory in a practical sense, was often obscured by many things (lack of ventricular filling, poor definition of commissures, thalamic assymetry). As a result, much of the localization and many of the results reported are difficult to interpret now because it is very hard to know exactly where electrodes were and where the lesions were. Lesions tended to be large; they were frequently placed somewhat arbitrarily without very good anatomical delineation. Furthermore, the pain pathway was not well understood, so thalamic lesion making did not have much chance of success. Most of the literature on diencephalic surgery and pain dating from the 1950s and 1960s is, therefore, very difficult to interpret. The lesions were made in a wide variety of places, the most common targets being the centrum medianum, the para-fascicular nucleus surrounding it, and specific thalamic sensory nuclei. The relevant papers are difficult to review. Most do not prove the localization of the lesion because the patients survived and histological specimens were not available. The size of the lesion is hard to determine given the rather crude lesion-making techniques of the time, and the criteria for the success of pain relief were indefinite at best. In fact, records show that the average follow-up duration for stereotactic pain surgery at that time was 3 months, so it was impossible to determine whether there was any long-term effect upon pain. Only a small amount of destructive thalamic surgery has persisted into this era. What we now know about the pain pathway might make a rebirth more fruitful, but most have stayed with stimulation rather than attempting to go back to destructive lesions. Some of the ideas presented in this volume may cause surgeons to rethink that position.


Electrical Stimulation Deep Brain Stimulation Brain Stimulation Pain Pathway Intractable Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Donlin M. Long
    • 1
  1. 1.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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