title: Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Graduate School of Medicine, Institute of Advanced Biomedical Technology & Science, Tokyo, Japan. GKRmoto@aol.com
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Takaomi
authors.initials: T
authors.lastname: Taira
authors.forename: Taku
authors.initials: T
authors.lastname: Ochiai
authors.forename: Mikhail
authors.initials: M
authors.lastname: Chernov
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takasu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Izawa
authors.forename: Nobuo
authors.initials: N
authors.lastname: Kouyama
authors.forename: Mihoko
authors.initials: M
authors.lastname: Tomida
authors.forename: Osamu
authors.initials: O
authors.lastname: Tokumaru
authors.forename: Yoko
authors.initials: Y
authors.lastname: Katayama
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
authors.forename: Kintomo
authors.initials: K
authors.lastname: Takakura
mesh_terms: 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