Abstract
Background
Motor cortex stimulation (MCS) is considered to be an effective treatment in some types of chronic refractory neuropathic pain. The aim of this study is to evaluate and confirm the feasibility, efficacy and security of our surgical technique for subdural motor cortex stimulation (SD MCS) on 18 consecutive cases with follow-up of at least 3 years.
Methods
Our population consists of 18 consecutive patients (12 male) between 2000 and 2010, with a mean age of 63 years (11–91). The mean follow-up was 86 months (20–140 months). We identified the central sulcus by using classical anatomic landmarks and neuronavigation (BrainLab system; BrainLAB, Inc., Redwood City, CA). An elongated craniotomy (3 cm in length, 1 cm in width) was performed followed by linear opening of the dura mater. An eight-polar plate electrode (Specify Lead, 3998; Medtronic, Minneapolis, MN) was then slipped smoothly through this linear opening. In patients with interhemispheric electrodes (patients 2 and 17), we performed a parasagittal craniotomy of 4 cm length and 2 cm width.
Results
At last follow-up assessment, 14 patients had a favourable outcome (77.7 %): 10 patients with excellent relief of pain (>80 %), 1 with good relief of pain (60–80 %) and 3 with satisfactory relief of pain (50–60 %). Four patients showed bad results (<50 %). We did not observe any late complications specific to SD MCS.
Conclusion
We report an efficacy at least as good as ED MCS, with no complications specific to SD MCS, even with prolonged follow-up. The data are insufficient to actually prove a lower energy use in SD MCS.
Similar content being viewed by others
References
Brown JA, Barbaro NM (2003) Motor cortex stimulation for central and neuropathic pain: current status. Pain 104:431–435
Carroll D, Joint C, Maartens N, Shlugman D, Stein J, Aziz TZ (2000) Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases. Pain 84:431–437
Delavallée M, Abu-Serieh B, de Tourtchaninoff M, Raftopoulos C (2008) Subdural motor cortex stimulation for central and peripheral neuropathic pain: a long-term follow-up study in a series of eight patients. Neurosurgery 63(1):101–105, discussion 105–8
Delavallée M, Rooijakkers H, Koerts G, Raftopoulos C (2011) Motor cortex stimulation in a three-year-old child with trigeminal neuropathic pain caused by a malignant glioma in the cerebellopontine angle: case report. Neurosurgery 69(2):E494–E496
Ebel H, Rust D, Tronnier V, Böker D, Kunze S (1996) Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir (Wien) 138:1300–1306
Fagundes-Pereyra WJ, Teixeira MJ, Reyns N, Touzet G, Dantas S, Laureau E, Blond S (2010) Motor cortex electric stimulation for the treatment of neuropathic pain Arq. Neuropsiquiatr 68(6):923–929
García-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D, Convers P, Mauguière F, Sindou M, Laurent B (1999) Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 83:259–273
Herregodts P, De Ridder F, Stadnik T, D’Haens J (1995) Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex. Acta Neurochir Suppl (Wien) 64:132–135
Holsheimer J, Nguyen JP, Lefaucheur JP, Manola L (2007) Cathodal, anodal or bifocal stimulation of the motor cortex in the management of chronic pain? Acta Neurochir Suppl 97:57–66
Hosobuchi Y, Adams JE, Rutkin B (1973) Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol 29:158–161
Hosomi K, Saitoh Y, Kishima H, Oshino S, Hirata M, Tani N, Shimokawa T, Yoshimine T (2008) Electrical stimulation of primary motor cortex within the central sulcus for intractable neuropathic pain. Clin Neurophysiol 119:993–1001
Katayama Y, Fukaya C, Yamamoto T (1998) Poststroke pain control by chronic motor cortex stimulation: Neurological characteristics predicting a favorable response. J Neurosurg 89:585–591
Kim D, Jun SC, Kim HI (2011) Computational study of subdural and epidural cortical stimulation of the motor cortex. Conf Proc IEEE Eng Med Biol Soc 2011:7226–7229
Manola L, Roelofsen BH, Holsheimer J, Geelen J, Marani E (2005) Modelling motor cortex stimulation for chronic pain control: electrical potential field, activating functions and responses of simple nerve fibre models. Med Biol Eng Comput 43:335–343
Manola L, Holsheimer J, Veltink P, Buitenweg JR (2007) Anodal vs cathodal stimulation of motor cortex: a modeling study. Clin Neurophysiol 118:464–474
Mazars GJ (1975) Intermittent stimulation of nucleus ventralis posterolateralis for intractable pain. Surg Neurol 48:93–95
Mertens P, Nuti C, Sindou M, Guenot M, Peyron R, Garcia-Larrea L, Laurent B (1999) Precentral cortex stimulation for the treatment of central neuropathic pain: results of a prospective study in a 20 patient series. Stereotact Funct Neurosurg 73:122–125
Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P (1993) Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl (Wien) 58:150–153
Mogilner AY, Rezai AR (2001) Epidural motor cortex stimulation with functional imaging guidance. Neurosurg Focus 11:E4
Nguyen JP, Keravel Y, Fève A, Uchiyama T, Cesaro P, Le Guerinel C, Pollin B (1997) Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases. Acta Neurochir Suppl 68:54–60
Nguyen JP, Lefaucheur JP, Decq P, Uchiyama T, Carpentier A, Fontaine D, Brugières P, Pollin B, Fève A, Rostaing S, Cesaro P, Keravel Y (1999) Chronic motor cortex stimulation in the treatment of central and neuropathic pain: correlations between clinical, electrophysiological and anatomical data. Pain 82:245–251
Nguyen JP, Nizard J, Keravel Y, Lefaucheur JP (2011) Invasive brain stimulation for the treatment of neuropathic pain. Nat Rev Neurol 7(12):699–709
Owen SL, Green AL, Nandi DD, Bittar RG, Wang S, Aziz TZ (2007) Deep brain stimulation for neuropathic pain. Acta Neurochir Suppl 97:111–116
Owen SL, Green AL, Stein JF, Aziz TZ (2006) Deep brain stimulation for the alleviation of post-stroke neuropathic pain. Pain 120:202–206
Pirotte B, Voordecker P, Joffroy F, Massager N, Wikler D, Baleriaux D, Levivier M, Brotchi J (2001) The Zeiss-MKM system for frameless image-guided approach in epidural motor cortex stimulation for central neuropathic pain. Neurosurg Focus 11:E3
Rainov NG, Fels C, Heidecke V, Burkert W (1997) Epidural electrical stimulation of the motor cortex in patients with facial neuralgia. Clin Neurol Neurosurg 99:205–209
Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ (2011) Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional cas series experience. Stereotact Funct Neurosurg 89(2):83–88
Saitoh Y, Hirano S, Kato A, Kishima H, Hirata M, Yamamoto K, Yoshimine T (2001) Motor cortex stimulation for deafferentation pain. Neurosurg Focus 15:E1
Saitoh Y, Hirayama A, Kishima H, Oshino S, Hirata M, Kato A, Yoshimine T (2006) Stimulation of primary motor cortex for intractable deafferentation pain. Acta Neurochir Suppl 99:57–59
Saitoh Y, Kato A, Ninomiya H, Baba T, Shibata M, Mashimo T, Yoshimine T (2003) Primary motor cortex stimulation within the central sulcus for treating deafferentation pain. Acta Neurochir Suppl 87:149–152
Saitoh Y, Shibata M, Hirano S, Hirata M, Mashimo T, Yoshimine T (2000) Motor cortex stimulation for central and peripheral deafferentation pain. Report of eight cases. J Neurosurg 92:150–155
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T (1985) Deafferentation pain and stimulation of the thalamic sensory relay nucleus: clinical and experimental study. Appl Neurophysiol 48:166–171
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S (1991) Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien) 52:137–139
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S (1993) Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78:393–401
Velasco F, Argüelles C, Carrillo-Ruiz JD, Castro G, Velasco AL, Jiménez F, Velasco M (2008) Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial. J Neurosurg 108(4):698–706
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Delavallée, M., Finet, P., de Tourtchaninoff, M. et al. Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years. Acta Neurochir 156, 2289–2294 (2014). https://doi.org/10.1007/s00701-014-2240-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-014-2240-4