Outcome after pituitary radiosurgery for thalamic pain syndrome.
OBJECTIVE
To evaluate outcomes after pituitary radiosurgery in patients with post-stroke thalamic pain syndrome.


METHODS
From 2002 to 2006, 24 patients with thalamic pain syndrome underwent pituitary radiosurgery at Tokyo Women's Medical University and were followed at least 12 months thereafter. The radiosurgical target was defined as the pituitary gland and its connection with the pituitary stalk. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was 35 months (range, 12-48 months).


RESULTS
Initial pain reduction, usually within 48 h after radiosurgery, was marked in 17 patients (71%). However, in the majority of cases the pain recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 5 patients (21%). Ten patients (42%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 1, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once.


CONCLUSIONS
Pituitary radiosurgery for thalamic pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. It can be used as a primary minimally invasive management option for patients with post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases pain recurrence occurs within 1 year after treatment.
Hayashi
Motohiro
M
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. GKRmoto@aol.com
Chernov
Mikhail F
MF
Taira
Takaomi
T
Ochiai
Taku
T
Nakaya
Kotaro
K
Tamura
Noriko
N
Goto
Shinichi
S
Yomo
Shoji
S
Kouyama
Nobuo
N
Katayama
Yoko
Y
Kawakami
Yoriko
Y
Izawa
Masahiro
M
Muragaki
Yoshihiro
Y
Nakamura
Ryoichi
R
Iseki
Hiroshi
H
Hori
Tomokatsu
T
Takakura
Kintomo
K
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010148:Intractable Pain / Q000601:surgery*; D010902:Pituitary Gland / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects; D011879:Radiotherapy Dosage; D020521:Stroke / Q000150:complications; D013577:Syndrome; D013786:Thalamic Diseases / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome