title: Image-guided motor cortex stimulation in patients with central pain.
abstract: According to recent clinical data, motor cortex stimulation (MCS) is an alternative treatment for central pain syndromes. We present our minimally invasive technique of image guidance for the placement of the motor cortex-stimulating electrode and assess the clinical usefulness of both neuronavigation and vacuum headrest. Five patients suffering from central pain underwent MCS with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany). The neuronavigation was used for identification of the precentral gyrus and accurate planning of the single burr hole. The exact location was reconfirmed by an intraoperative stimulation test. Postoperative clinical and neuroradiological evaluations were performed in each patient. The navigation system worked properly in all 5 neurosurgical cases. Determination of the placement of stimulating electrode was possible in every case. All patients obtained postoperative pain relief. No surgical complication occurred, and the postoperative course was uneventful in all patients. This preliminary experience may confirm image guidance as a useful tool for the surgery of MCS. Additionally, minimal and safe exposure can be achieved using a single burr hole and vacuum headrest.
authors.affiliation: Department of Neurosurgery, Philipps University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Tirakotai
authors.forename: T
authors.initials: T
authors.lastname: Riegel
authors.forename: U
authors.initials: U
authors.lastname: Sure
authors.forename: J
authors.initials: J
authors.lastname: Rohlfs
authors.forename: A
authors.initials: A
authors.lastname: Gharabaghi
authors.forename: H
authors.initials: H
authors.lastname: Bertalanffy
authors.forename: D
authors.initials: D
authors.lastname: Hellwig
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D005157:Facial Pain / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D038361:Neuronavigation / Q000295:instrumentation; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014618:Vacuum