Evaluation of Stereotactic Thalamotomies for Pain Relief with Reference to Pulvinar Intervention

Abstract

Stereotactic thalamotomies were carried out in 51 cases of malignant tumors and 9 cases of other painful conditions. The patients were divided into two groups – those with a relatively small lesion created in the basal part of the CM nucleus and those with a larger lesion extending into the pulvinar. In total, 50% of the cases showed complete pain relief, 20% partial relief and 30% no effect. The group with pulvinar intervention showed better results, especially those with malignancies.

Central Mechanisms of Peripheral Nerve Stimulation in Headache Disorders

“…In the paresthesia state during neurostimulation, ACC and left pulvinar activation were observed indicating that ONS can modulate activity in the thalamus. Indeed, the pulvinar has been suggested to be involved in pain modulation as neurosurgical pulvinotomy has been performed in relieving intractable pain [79,80]. Preliminary analysis of a PET study in chronic cluster headache treated with ONS suggests that the cerebral reward system, including the ventral striatum and nucleus accumbens, may mediate an additional effect [81].…”

Anatomy and Physiology of Pain Referral Patterns in Primary and Cervicogenic Headache Disorders

“…Indeed, the pulvinar has been suggested as being involved in pain modulation as neurosurgical pulvinotomy has been performed to relieve intractable pain (Figure 4). 47,48 …”

“…Indeed, the pulvinar has been suggested as being involved in pain modulation as neurosurgical pulvinotomy has been performed to relieve intractable pain ( Figure 4). 47,48 The suboccipital stimulation in this study is similar to the stimulation of the spinal cord and dorsal column stimulation 45,49 where segmental circuits or ascending tracts of the spinal cord, or both, are stimulated. Here, the therapeutic effect is mostly restricted to the spinal cord segment of the stimulated afferents.…”