Skip to main content
SpringerLink
Log in

Medial Thalamotomy with the Leksell Gamma Knife for Treatment of Chronic Pain

  • Conference paper
Advances in Radiosurgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 62))

Summary

The authors describe 10 patients who underwent stereotactic medial thalamotomy with the Leksell Gamma Knife for treatment of chronic intractable pain. The pain was related to structural spinal disorders (4), postherpetic neuralgia (2), spinal cord injury (1), thalamic syndrome (1), anesthesia dolorosa of the face (1), and brainstem infarction (1). All patients had undergone extensive treatment with a variety of modalities prior to gamma thalamotomy. Nine patients underwent unilateral and one patient bilateral lesions. Magnetic resonance imaging (MRI) was used for target localization and the lesions were directed toward the intralaminar nuclei, the lateral portion of the medial dorsal nucleus, the centrum medianum and parafascicular nuclei. The lesions were made with radiation doses of 160–180Gy using a 4 mm beam collimator and either a single isocenter (1 patient) or two isocenters (9 patients).

Follow-up MRI scans in all patients showed well localized lesions. Three patients experienced excellent pain relief, four had good pain relief and three were failures. No complications were seen in any of the patients. In the past gamma thalamotomy was used mainly for treatment of pain related to malignancies but our results indicate that it may also be a safe and effective treatment for pain of nonmalignant origin as well.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Albe-Fessard D, Kruger L (1962) Duality of unit discharges from cat centrum medianum in response to natural and electrical stimulation. J Neurophysiol 25: 3–20

    PubMed  CAS  Google Scholar 

  2. Albe-Fessard D, Besson JM (1973) Convergent thalamic and cortical projections — the nonspecific system. In: lggo A (ed) Handbook of sensory physiology, Vol II. Somatosensory system. Springer, Berlin Heidelberg New York, pp 490–560

    Google Scholar 

  3. Albe-Fessard D, Condes-Lara M, Sanderson, et al (1984) Tentative explanation of the special role played by the areas of paleospinothalamic projection in patients with deafferentation pain syndromes. In: Kruger L, Liebeskind JC (eds) Advances in pain research and therapy, Vol 6. Raven, New York, pp 167–182

    Google Scholar 

  4. Alexander E, Lindquist C (1993) Special indications: radiosurgery for functional neurosurgery and epilepsy. In: Alexander E, Loeffler JS, Lunsford LD (eds) Stereotactic radiosurgery. McGraw-Hill, New York, pp 221–225

    Google Scholar 

  5. Anderson KV, Mahan PE (1971) Increased pain thresholds following combined lesions of thalamic nuclei centrum medianum and centralis lateralis. Psychon Sei 23: 113–114

    Article  Google Scholar 

  6. Birg W, Mundinger F, Mohadier M, et al (1985) X-ray and magnetic resonance stereotaxy for functional and nonfunctional neurosurgery. Appl Neurophysicol 48: 22–29

    CAS  Google Scholar 

  7. Bowsher D (1976) Role of the reticular formation in responses to noxious stimulation. Pain 2: 361–378

    Article  PubMed  CAS  Google Scholar 

  8. Bushnell MC, Duncan GH (1989) Sensory and affective aspects of pain perception: is medial thalamus restricted to emotional issues? Exp Brain Res 78: 415–418

    Article  PubMed  CAS  Google Scholar 

  9. Cesaro P, Mann MW, Moretti JL, et al (1991) Central pain and thalamic hyperactivity: a single photon emission computerized tomographic study. Pain 47: 329–336

    Article  PubMed  CAS  Google Scholar 

  10. Chodakiewitz JW (1991) Thalamotomy lesions: letter to the editor. J Neurosurg 75: 832–833

    PubMed  CAS  Google Scholar 

  11. Craig, Jr AD, Linington AJ, Kniffki KD (1989) Cells of origin of spinothalamic tract projections to the medial and lateral thalamus in the cat. J Comp Neurol 289: 568–585

    Article  PubMed  Google Scholar 

  12. Dafny N, Reyes-Vazquez C, Qiao JT (1990) Modification of nociceptively identified neurons in thalamic parafascicularis by chemical stimulation of dorsal raphe with glutamate, morphine, serotonin and focal dorsal raphe electrical stimulation. Brain Res Bull 24: 717–723

    Article  PubMed  CAS  Google Scholar 

  13. Dostrovsky JO, Guildbaud G (1990) Nociceptive responses in medial thalamus of the normal and arthritic rat. Pain 40: 93–104

    Article  PubMed  CAS  Google Scholar 

  14. Fairman D (1966) Evaluation of results in stereotactic thalamotomy for the treatment of intractable pain. Confin Neurol 27: 67–70

    Article  PubMed  CAS  Google Scholar 

  15. Fairman D (1967) Unilateral thalamic tractomy for the relief of bilateral pain in malignant tumors. Confin Neurol 29: 146–158

    Article  PubMed  CAS  Google Scholar 

  16. Fairman D, Llavallol MA (1973) Thalamic tractotomy for the alleviation of intractable pain in cancer. Cancer 31: 700–707

    Article  PubMed  CAS  Google Scholar 

  17. Feinberg WM, Rapcsak SZ (1989) ‘Peduncular hallucinosis’ following paramedian thalamic infarction. Neurology 39: 1535–1536

    Google Scholar 

  18. Forster DMC, Leksell L, Meyerson BA, et al (1972) Gammathalamotomy in intractable pain. In: Janzen R, Keidel WD, Herz A, Steichele C (eds) Pain: basic principles-pharmacology therapy. Thieme, Stuttgart, pp 194–198

    Google Scholar 

  19. Giesler GJ, Menetrey D, Basbaum AI (1979) Differential origins of spinothalamic tract projections to medial and lateral thalamus in the rat. J Comp Neurol 184: 107–126

    Article  PubMed  Google Scholar 

  20. Giesler GJ, Spiel HR, Willis WD (1981) Organization of spinothalamic tract axons within the rat spinal cord. J Comp Neurol 195: 243–252

    Article  PubMed  Google Scholar 

  21. Gorecki J, Hirayama T, Dostrovsky JO, et al (1989) Thalamic stimulation and recording in patients with deafferentation and Central Pain. Stereotactic Funct Neurosurg 52: 219–226

    Article  CAS  Google Scholar 

  22. Gucer G, Neidermeyer E, Long DM (1978) Thalamic recordings in patients with chronic pain J Neurol 219: 47–61

    CAS  Google Scholar 

  23. Gybels JM, Sweet WH (1989) Neurosurgical treatment of persistent pain. Thalamotomy. In: Gildenberg PL (ed) Pain and headache, Vol 16. Karger, Basel, pp 220–234

    Google Scholar 

  24. Hageman R, DeGrood MPAM (1970) Experiences with stereotactic treatment of intractable pain. Psychiatry Neurology Neurosurgery 73: 113–134

    CAS  Google Scholar 

  25. Hassler R (1972) The division of pain conduction into systems of pain sensation and pain awareness. In: Janzen R, Keidel WD, Herz A, Steichele C (eds) Pain: basic principles-pharmacology therapy. Thieme, Stuttgart, pp 98–112

    Google Scholar 

  26. Hirai T, Jones EG (1989) A new panellation of the human thalamus on the basis of histochemical staining. Brain Res Rev 14: 1–34

    Article  PubMed  CAS  Google Scholar 

  27. Hirayama T, Dostrovsky JO, Gorecki J et al (1989) Recordings of abnormal activity in patients with deafferentation and central pain. Stereotact Funct Neurosurg 52: 120–126

    Article  PubMed  CAS  Google Scholar 

  28. Hitchcock ER, Teixeria MJ (1981) A comparison of results from center-median and basal thalamotomies for pain. Surg Neurol 15: 341–351

    Article  PubMed  CAS  Google Scholar 

  29. Hood TW, Yap JC (1981) A survey of infections in stereotactic surgery. Appl Neurophysiol 44: 314–319

    PubMed  CAS  Google Scholar 

  30. Ishijima B, Yoshimasu N, Fukushima T, et al (1975) Nociceptive neurons in the human thalamus. Confinia Neurol 37: 99–106

    Article  CAS  Google Scholar 

  31. Jones EG (1985) The thalamus. Plenum, New York, pp 607–645

    Book  Google Scholar 

  32. Keyser V, Guilbaud G (1984) Further evidence for changes in the responsiveness of somatosensory neurons in arthritic rats: a study of the posterior intralaminar region of the thalamus. Brain Res 323: 144–147

    Article  Google Scholar 

  33. Kelly PJ (1991) Thalamotomy lesions: response to letter to the editor. J Neurosurg 75: 833–834

    Google Scholar 

  34. Kondziolka D, Dolan EJ, Tasker RR (1989) Functional stereotactic surgery and stereotactic biopsy using a magnetic resonance imaging directed system. Results and comparisons to CT guidance. Presented at the 10th Meeting of the World Society for Stereotactic and Functional Neurosurgery. Maebashi, Japan

    Google Scholar 

  35. Kritchevsky M, Graff-Radford NR, Damasio AR (1987) Normal memory after damage to the medial thalamus. Arch Neurol 44: 959–962

    Article  PubMed  CAS  Google Scholar 

  36. Kritchevsky M, Graff-Radford NR (1989) Medial thalamus and memory: reply to letter to the editor. Arch Neurol 46: 483–484

    Article  Google Scholar 

  37. Laitinen LV (1988) Mesencephalotomy and thalamotomy for chronic pain. In: Lundsford LD (ed) Modern stereotactic neurosurgery. Martinus Nijhoff, Boston, pp 269–277

    Google Scholar 

  38. Leksell L, Meyerson BA, Forster DMC (1972) Radiosurgical thalamotomy for intractable pain. Confin Neurol 34: 264

    Article  Google Scholar 

  39. Lunsford LD (1988) Magnetic resonance imaging stereotactic thalamotomy: report of a case with comparison to computed tomography. Neurosurgery 23: 363–367

    Article  PubMed  CAS  Google Scholar 

  40. Ma W, Peschanski M, Ralston HJ (1987) Fine structure of the spinothalamic projections to the central lateral nucleus of the rat thalamus. Brain Res 414: 187–191

    Article  PubMed  CAS  Google Scholar 

  41. Mark VH, Ervin FR, Hackett TP (1960) Clinical aspects of stereotactic thalamotomy in the human in the treatment of chronic serve pain. Arch Neurol 3: 351–367

    Article  PubMed  CAS  Google Scholar 

  42. Mark VH, Ervin FR (1965) Role of thalamotomy in treatment of chronic severe pain. Postgrad Med 37: 563–571

    PubMed  CAS  Google Scholar 

  43. Mark VH, Ervin FR, Yakolev PI (1971) Correlation of pain relief, sensory loss and anatomical lesion sites in pain patients treated by stereotaxic thalamotomy. Trans Am Neurol Assoc 86: 86–90

    Google Scholar 

  44. Marlbrug DL (1973) The effect on reaction of painful stimuli of lesions in the centromedian nucleus in the thalamus of the monkey. Intern J Neurosci 5: 153–158

    Article  Google Scholar 

  45. McKenzie JS, Rogers DK (1981) Unit responses of intralaminar thalamus to midbrain and medullary stimulation and effects of conditioning caudate and hippocampal stimuli. Brain Res Bull 7: 345–352

    Article  PubMed  CAS  Google Scholar 

  46. Mehler WR (1966) Further notes on the center median nucleus of macague. In: Purpura DP, Yahr MD (eds) The thalamus. Columbia University Press, New York, pp 109–122

    Google Scholar 

  47. Mitchell CL, Kaelber WW (1966) Effect of medial thalamic lesions on responses elicited by tooth pulp stimulaton. Am J Neurol 210: 263–269

    CAS  Google Scholar 

  48. Mitchell CL, Kaelber WW (1967) Unilateral vs. bilateral medial thalamic lesions and reactivity to noxious stimuli. Arch Neurol 17: 653–660

    Article  PubMed  CAS  Google Scholar 

  49. Mori E, Yamadori A (1989) Medial thalamus and memory: letter to the editor. Arch Neurol 46: 482–483

    Article  PubMed  CAS  Google Scholar 

  50. Niizuma H, Kwak R, Ikeda S, et al (1982) Follow-up results of centromedian thalamotomy for central pain. Appl Neurophysiol 45: 324–325

    PubMed  CAS  Google Scholar 

  51. Olausson B, Shyu BC, Rydenhag B (1989) Projection from the thalamic intralaminar nuclei on the isocortex of the rat: a surface potential study. Exp Brain Res 75: 543–554

    Article  PubMed  CAS  Google Scholar 

  52. Palestini M, Mariotti M, Velasco, et al (1987) Medialis dorsalis thalamic unitary response to tooth pulp stimulation and its conditioning by brainstem and limbic activation. Neurosci Lett 78: 161–165

    Article  PubMed  CAS  Google Scholar 

  53. Pearl GS, Anderson KV (1980) Response of cells of feline nucleus centrum medianum to tooth pulp stimulation. Brain Res Bull 5: 41–45

    Article  PubMed  CAS  Google Scholar 

  54. Richardson DE (1967) Thalamotomy for intractable pain. Confin Neurol 29: 139–145

    Article  PubMed  CAS  Google Scholar 

  55. Rinaldi PC, Young RF, Albe-Fessard D, et al (1991) Spontaneous neuronal hyperactivity in the intralaminar thalamic nuclei of patients with deafferentation pain. J Neursurg 74: 415–421

    Article  CAS  Google Scholar 

  56. Sadikot AF, Parent A, François C (1990) The centre médian and parafascicular thalamic project respectively to the sensorimotor and associative-limbic striatal territories in the squirrel monkey. Brain Res 510: 161–165

    Article  PubMed  CAS  Google Scholar 

  57. Sano K (1977) Intralaminar thalamotomy (thalamolaminotomy) and posteromedial hypothalamotomy in the treatment of intractable pain. Prog Neurol Surg 8: 50–103

    Google Scholar 

  58. Sano K, Yoshioka M, Ogashiwa M, et al. (1966) Thalamolaminotomy: a new operation relief of intractable pain. Confin Neurol 27: 63–66

    Article  PubMed  CAS  Google Scholar 

  59. Schaltenbrand G, Wahren W (1977) Atlas for stereotaxy of the human brain. Thieme, Stuttgart

    Google Scholar 

  60. Steiner L, Forster D, Leksell L, et al (1980) Gammathalamotomy in intractable pain. Acta Neurochir (Wien) 52: 173–184

    Article  CAS  Google Scholar 

  61. Sugita K, Mutsuga N, Takaoka Y, et al. (1972) Results of stereotaxic thalamotomy for pain. Confin Neurol 34: 265–274

    Article  Google Scholar 

  62. Tasker RR (1989) Stereotactic surgery. In: Wall PD, Melzack R (eds) Textbook of pain, 2nd Ed. Churchill Livingstone, Edinburgh, pp 840–855

    Google Scholar 

  63. Tasker RR (1990) Thalamotomy. Neurosurg Clin North Am 1: 841–863

    CAS  Google Scholar 

  64. Takaku A, Kwak R, Sakamoto T, et al (1973) Stereotactic thalamotomy for postherpetic central pain and muscular hyper- tonicity. Tohoku J Exp Med 85: 87–92

    Google Scholar 

  65. Tsubokawa T, Mariyasu N (1975) Follow-up results of centre median thalamotomy for relief of intractable pain. Conf Neurol 37: 280–284

    Article  CAS  Google Scholar 

  66. Tomlinson FH, Jack CR, Kelly PJ (1991) Sequential magnetic resonance imaging following stereotactic radiofrequency ventralis lateralis thalamotomy. J Neurosurgery 74: 579–584

    Article  CAS  Google Scholar 

  67. van Vulpen EHS, Verwer RWH (1989) Organization of projections from the mediodorsal nucleus of the thalamus to the basolateral complex of the amygdala in the rat. Brain Res 500: 389–394

    Article  PubMed  Google Scholar 

  68. Watson RT, Valenstein E, Heilman KM (1981) Thalamic neglect. Possible role of the medial thalamus and nucleus reticularis in behavior. Arch Neurol 38: 501–506

    Google Scholar 

  69. Wennerstrand J, Ungestedt U (1970) Anatomical study of gamma-radiolesions. Acta Chir Scand 136: 133–137

    PubMed  CAS  Google Scholar 

  70. Young RF, Modesti L (1985) Stereotactic ablative procedure for pain relief. In: Wilkins RH, Regachary SS (eds) Neurosurgery. McGraw Hill, New York, pp 2454–2457

    Google Scholar 

  71. Young RF (1988) Stereotactic methods in management of pain. In: Heilbrun MP (ed) Concepts in neurosurgery, Stereotactic neurosurgery. Williams and Wilkins, Baltimore, pp 149–160

    Google Scholar 

  72. Young RF (1992) Stereotactic surgical ablation for pain relief. In: Rengachary SS, Wilkins RH (eds) Neurosurgical operative atlas. Williams and Wilkins, Baltimore, pp 177–188

    Google Scholar 

  73. Young RF (1988) Functional stereotactic neurosurgery with magnetic resonance imaging guidance. J Mind Behavior 9: 263–272

    Google Scholar 

  74. Young RF (1993) Intracranial procedures for pain management. In: Apuzzo MLJ (ed) Brain surgery: complication avoidance and management. Churchill Livingstone, New York, pp 1497–150

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Northwest Hospital Gamma Knife Center, 11560 North 115th Street, Suite G-5, Seattle, WA, 98133, USA

    Ronald F. Young M.D.

  2. Good Samaritan Hospital Neuroscience/Gamma Knife Center, Los Angeles, CA, USA

    D. S. Jacques, R. W. Rand & B. R. Copcutt

Authors
  1. Ronald F. Young M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. S. Jacques
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. W. Rand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. R. Copcutt
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Gamma Knife Center, Karolinska Hospital, Stockholm, Sweden

    Christer Lindquist

  2. Department of Neurological Surgery and Radiation Oncology, Presbyterian University Hospital, Pittsburgh, PA, USA

    Douglas Kondziolka

  3. Joint Center of Radiation Therapy, Boston, MA, USA

    Jay S. Loeffler

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer-Verlag

About this paper

Cite this paper

Young, R.F., Jacques, D.S., Rand, R.W., Copcutt, B.R. (1994). Medial Thalamotomy with the Leksell Gamma Knife for Treatment of Chronic Pain. In: Lindquist, C., Kondziolka, D., Loeffler, J.S. (eds) Advances in Radiosurgery. Acta Neurochirurgica Supplementum, vol 62. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9371-6_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-9371-6_22

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-9373-0

  • Online ISBN: 978-3-7091-9371-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation