Chronic neurogenic pain and the medial thalamotomy.
69 patients suffering from chronic therapy-resistant neurogenic pain of peripheral and/or central origin underwent a stereotactic medial thalamotomy. Medial thalamic unit recordings were performed peroperatively, allowing the physiological confirmation of the electrode location and the recognition of a specific physiopathology. Thanks to these recordings, a concept was developed, based on the presence of an imbalance between medial (nucleus centralis lateralis mainly) and lateral (nucleus ventroposterior) thalamic nuclei, resulting in an over-inhibition of both by the reticular thalamic nucleus, and then in a paradoxical activation of pain-related cortical areas. The medial thalamotomy, re-actualized by new technical, anatomical and physiological data, offers a 50-100% relief to 67% of all patients with peripheral as well as central neurogenic pain, on all body localizations, without producing neurological deficits and without risk for the development of iatrogenic pain.
Jeanmonod
D
D
Labor für Funktionelle Neurochirurgie, Universitätsspital Zürich.
Magnin
M
M
Morel
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000601:surgery*; D010146:Pain / Q000601:surgery*; D010147:Pain Measurement; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery*