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Minim Invasive Neurosurg 2004; 47(5): 273-277
DOI: 10.1055/s-2004-830092
Original Article
© Georg Thieme Verlag Stuttgart · New York

Image-Guided Motor Cortex Stimulation in Patients with Central Pain

W.  Tirakotai1 , T.  Riegel1 , U.  Sure1 , J.  Rohlfs1 , A.  Gharabaghi2 , H.  Bertalanffy1 , D.  Hellwig1
  • 1Department of Neurosurgery, Philipps University, Marburg, Germany
  • 2Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany
Further Information

Publication History

Publication Date:
02 December 2004 (online)

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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.

Key words

Central pain - intraoperative somatosensory - motor cortex stimulation - neuronavigation - thalamic pain

References

  • 1 Carroll D, Joint C, Maartens N, Shlugman D, Stein J, Aziz T Z. Motor cortex stimulation for chronic neuropathic pain: A preliminary study of 10 cases.  Pain. 2000;  84 431-437
    CrossrefPubMedGoogle Scholar
  • 2 Nguyen J P, Lefaucheur J P, Decq P, Uchiyama T, Carpentier A, Fontaine D, Brugieres P, Pollin B, Feve A, Rostaing S, Cesaro P, Keravel Y. Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlation between clinical, electrophysiological and anatomical data.  Pain. 1999;  82 245-251
    CrossrefPubMedGoogle Scholar
  • 3 Saitoh Y, Shibata M, Hirano S I, Hirata M, Mashimo T, Yoshimine T. Motor cortex stimulation for central and peripheral deafferentation pain.  J Neurosurg. 2000;  92 150-155
    CrossrefPubMedGoogle Scholar
  • 4 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain.  Acta Neurochir (Wien). 1991;  52 (Suppl) 137-139
    PubMedGoogle Scholar
  • 5 Velasco M, Velasco F, Brito F, Velasco A L, Nguyen J P, Marquez I, Boleaga B, Keravel Y. Motor cortex stimulation in the treatment of deafferentation pain. I. Localization of the motor cortex.  Stereotact Funct Neurosurg. 2002;  79 146-167
    PubMedGoogle Scholar
  • 6 Taylor J, Haughton A M. Determination of the Rolandic and Sylvian fissure.  Trans Acad Ireland. 1990;  18 511-526
    PubMedGoogle Scholar
  • 7 King R B, Schnell G R. Cortical localization and monitoring during cerebral operations.  J Neurosurg. 1987;  67 210-219
    PubMedGoogle Scholar
  • 8 Wood C C, Spencer D D, Allison T, McCarthy G, Williamson P D, Goff W R. Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials.  J Neurosurg. 1988;  68 99-111
    PubMedGoogle Scholar
  • 9 Nguyen J P, Keravel Y, Feve A, Uchiyama T, Cesaro P, Le Guerinel C, Pollin B. Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases.  Acta Neurochir (Wien). 1997;  68 (Suppl) 54-60
    PubMedGoogle Scholar
  • 10 Peyron R, Garcia-Larrea L, Deiber M P, Cinotti L, Convers P, Sindou M, Mauguiere F, Laurent B. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study.  Pain. 1995;  62 275-286
    CrossrefPubMedGoogle Scholar
  • 11 Rainov N G, Heidecke V. Motor cortex stimulation for neuropathic facial pain.  Neurol Res. 2003;  25 157-161
    CrossrefPubMedGoogle Scholar
  • 12 Saitoh Y, Shibata M, Hirano S I, Kato A, Kishima H, Hirata M, Yamamoto K, Yoshimine T. Motor cortex stimulation for deafferentation pain.  Neurosurg Focus. 2001;  11 1-5
    PubMedGoogle Scholar
  • 13 Franzini A, Ferroli P, Dones I, Marras C, Broggi G. Chronic motor cortex stimulation for movement disorders: a promising perspective.  Neurol Res. 2003;  25 123-126
    CrossrefPubMedGoogle Scholar
  • 14 Gumprecht H K, Widenka D C, Lumenta C B. BrainLab VectorVision neuronavigation system: technology and clinical experiences in 131 cases.  Neurosurgery. 1999;  44 97-105
    CrossrefPubMedGoogle Scholar
  • 15 Tirakotai W, Sure U, Benes L, Krischek B, Bien S, Bertalanffy H. Image-guided transsylvian, transinsular approach for insular cavernous angiomas.  Neurosurgery. 203;  53 1299-1304
    PubMedGoogle Scholar
  • 16 Alberti O, Riegel T, Hellwig D, Bertalanffy H. Frameless navigation and endoscopy.  J Neurosurg. 2001;  95 541-543
    PubMedGoogle Scholar
  • 17 Hellwig D, Bauer B L, Schulte D M, Gatscher S, Riegel T, Bertalanffy H. Neuroendoscopic treatment for colloid cysts of the third ventricle: The experience of a decade.  Neurosurgery. 2003;  52 525-532
    PubMedGoogle Scholar
  • 18 Tirakotai W, Riegel T, Sure U, Bozinov O, Hellwig D, Bertalanffy H. Clinical application of neuro-navigation in a series of single burr-hole procedures.  Zentralbl Neurochir. 2004;  65 1-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Golfinos J G, Fitzpatrick B C, Smith L R, Spetzler R F. Clinical use of a frameless stereotactic arm: results of 325 cases.  J Neurosurg. 1995;  83 197-205
    CrossrefPubMedGoogle Scholar
  • 20 Grunert P, Muller-Forell W, Darabi K, Reisch R, Busert C, Hopf N, Perneczky A. Basic principles and clinical applications of neuronavigation and intraoperative computed tomography.  Comput Aided Surg. 1998;  3 166-173
    CrossrefPubMedGoogle Scholar
  • 21 Reinhardt H F, Trippel M, Westermann B, Horstmann G A, Gratzl O. Computer assisted brain surgery for small lesions in the central sensorimotor region.  Acta Neurochir (Wien). 1996;  138 200-205
    CrossrefPubMedGoogle Scholar
  • 22 Sure U, Benes L, Riegel T, Schulte D M, Bertalanffy H. Image fusion of skull base neuronavigation - Technical note.  Neurol Med Chir (Tokyo). 2002;  42 458-462
    PubMedGoogle Scholar
  • 23 Rao S M, Binder J R, Hammeke T A, Bandettini P A, Bobholz J A, Frost J A, Myklebust B M, Jacobson R D, Hyde J S. Somatotopic mapping of the human primary motor cortex with functional magnetic resonance imaging.  Neurology. 1995;  45 919-924
    CrossrefPubMedGoogle Scholar
  • 24 Nguyen J P, Lefaucheur J P, Le Guerinel C, Fontanine D, Nakano N, Sakka L, Eizenbaum J F, Pollin B, Keravel Y. Treatment of central and neuropathic facial pain by chronic stimulation of the motor cortex: value of neuronavigation guidance systems for the localization of the motor cortex.  Neurochirurgie. 2000;  46 483-491
    PubMedGoogle Scholar
  • 25 Brown J A, Barbaro N M. Motor cortex stimulation for central and neuropathic pain: current status.  Pain. 2003;  104 431-435
    CrossrefPubMedGoogle Scholar
  • 26 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation in patients with thalamic pain.  J Neurosurg. 1993;  78 393-401
    CrossrefPubMedGoogle Scholar

Wuttipong TirakotaiM. D., M. Sc. 

Neurochirurgische Klinik der Philipps Universität Marburg

Baldingerstraße

35033 Marburg

Germany

Phone: +49-6421-286-6447

Fax: +49-6421-286-6415 ·

Email: hellwigd@med.uni-marburg.de

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