title: Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years.
abstract: BACKGROUND
  Motor cortex stimulation (MCS) is considered to be an effective treatment in some types of chronic refractory neuropathic pain. The aim of this study is to evaluate and confirm the feasibility, efficacy and security of our surgical technique for subdural motor cortex stimulation (SD MCS) on 18 consecutive cases with follow-up of at least 3 years.
  
  
  METHODS
  Our population consists of 18 consecutive patients (12 male) between 2000 and 2010, with a mean age of 63 years (11-91). The mean follow-up was 86 months (20-140 months). We identified the central sulcus by using classical anatomic landmarks and neuronavigation (BrainLab system; BrainLAB, Inc., Redwood City, CA). An elongated craniotomy (3 cm in length, 1 cm in width) was performed followed by linear opening of the dura mater. An eight-polar plate electrode (Specify Lead, 3998; Medtronic, Minneapolis, MN) was then slipped smoothly through this linear opening. In patients with interhemispheric electrodes (patients 2 and 17), we performed a parasagittal craniotomy of 4 cm length and 2 cm width.
  
  
  RESULTS
  At last follow-up assessment, 14 patients had a favourable outcome (77.7 %): 10 patients with excellent relief of pain (>80 %), 1 with good relief of pain (60-80 %) and 3 with satisfactory relief of pain (50-60 %). Four patients showed bad results (<50 %). We did not observe any late complications specific to SD MCS.
  
  
  CONCLUSIONS
  We report an efficacy at least as good as ED MCS, with no complications specific to SD MCS, even with prolonged follow-up. The data are insufficient to actually prove a lower energy use in SD MCS.
authors.affiliation: Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10 1200, Brussels, Belgium.
authors.forename: Maxime
authors.initials: M
authors.lastname: Delavallée
authors.forename: Patrice
authors.initials: P
authors.lastname: Finet
authors.forename: Marianne
authors.initials: M
authors.lastname: de Tourtchaninoff
authors.forename: Christian
authors.initials: C
authors.lastname: Raftopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000601:surgery*; D009437:Neuralgia / Q000601:surgery*; D038361:Neuronavigation; D013355:Subdural Space / Q000601:surgery*; D016896:Treatment Outcome