Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome.
OBJECTIVE
Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain.


METHODS
Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months.


CONCLUSIONS
An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.
Hayashi
Motohiro
M
Department of Neurosurgery, Neurological Institute, Graduate School of Medicine, Institute of Advanced Biomedical Technology & Science, Tokyo, Japan. GKRmoto@aol.com
Taira
Takaomi
T
Ochiai
Taku
T
Chernov
Mikhail
M
Takasu
Yuichi
Y
Izawa
Masahiro
M
Kouyama
Nobuo
N
Tomida
Mihoko
M
Tokumaru
Osamu
O
Katayama
Yoko
Y
Kawakami
Yoriko
Y
Hori
Tomokatsu
T
Takakura
Kintomo
K
D000368:Aged; D002543:Cerebral Hemorrhage / Q000503:physiopathology / Q000601:surgery; D002544:Cerebral Infarction / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D010147:Pain Measurement; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D011829:Radiation Dosage; D016634:Radiosurgery / Q000295:instrumentation*; D013577:Syndrome; D013786:Thalamic Diseases / Q000503:physiopathology / Q000601:surgery*; D013788:Thalamus / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery