Further Studies on the Stereotaxic Thalamotomy for Pain Relief

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  • YOSHII NOBUO
    Division of Neurological Surgery, Department of Surgery, Keio University School of Medicine
  • ADACHI KAZUMA
    Division of Neurological Surgery, Department of Surgery, Keio University School of Medicine
  • KUDO TATSUYUKI
    Division of Neurological Surgery, Department of Surgery, Keio University School of Medicine
  • SHIMIZU SHIRO
    The Seishin-Igaku Institute
  • NISHIOKA SHINKO
    The Seishin-Igaku Institute
  • NAKAHAMA HIROSHI
    Division of Neurophysiology, Institute of Brain Diseases, Tohoku University School of Medicine

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In animal experiments, the activity of 161 thalamic pulvinar neurons was studied in cats using the following stimuli; bending hairs, tapping the superficial and deep tissues, pinching the skin, scratching the peritoneum, stretching the mesentery, administration of acetylcholine and bradykinin into the mesenteric artery, and presentation of tones and light. Approximately a half of the pulvinar neurons responded to either of these stimuli. Occlusion among somatic, visceral, visual and auditory inputs was a common observation. The stereotaxic thalamotomy was performed on 20 patients suffering from intractable pain. Complete relief of the pain without appreciable sensory loss was obtained in 12 cases, which consisted of 10 cases of malignant tumor and 2 cases of postcerebrovascular disease. Good or fair effect was obtained in 8 cases. The anatomical verification of 2 brains indicated that each of the dorsal pulvinar nucleus, the fornix and the corpus callosum was partially destroyed. It is suggested that excellent effects may be expected, if the operation is performed stereotaxically on patients who need narcotics or strong analgesics for pain relief.

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