Publication details
Stereotaktická operační technika v terapii bolesti - historie a současné možnosti
| Title in English | Stereotactic surgery in pain treatment - history and contemporary possibilities |
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| Authors | |
| Year of publication | 2013 |
| Type | Article in Periodical |
| Magazine / Source | Bolest |
| MU Faculty or unit | |
| Citation | |
| Web | http://www.tigis.cz/images/stories/Bolest/2013/01/02_chrastina.pdf |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | stereotaxy; pain surgery; neuromodulation; deep brain stimulation; lesional stereotaxy |
| Attached files | |
| Description | Treatment of intractable pain became an integral part of functional stereotactical neurosurgery shortly after the first stereot actic brain surgery was performed in 1946. The aim of stereotactical surgeries in the treatment of pain is the modulation of structures and neural pathways respon- sible for the transmission of painful stimuli and underlying emotional processes associated with pain perception. Similarly to other stereotacti- cal functional surgeries (movement disorders, intractable epilepsy, treatment resistant psychiatric problems) the stereotactica l surgeries aiming to treat pain can be divided into lesional surgeries – destructive (anatomical destruction of target structure – using electroc oagulation in the majority of cases and a stimulation surgeries – neuromodulation (modulation of the target structure by means of the implantable generato r). The necessary preconditions for the use of stereotactical surgical technique for pain treatment were the new knowledge in the field of pain p athophysiology, reliable stereotactic frame based systems, the development of radiological and electrophysiological techniques for target structure iden tification and confir- mation and the progress in the field of implantable generators. During history the target structures for stereotactic pain trea tment were spinal cord and brainstem regions, hypothalamus, pituitary gland, specific and non specific thalamic nuclei and cingulate gyrus. Irreversib ility of targ et structure destruction and therefore also of side effects are the principal disadvantages of lesional surgeries. Lesional surgeries are th erefore only exceptio- nally performed nowadays. The main advantageous features of stereotactic neuromodulation system are minimalisation of the exten t of anatomi- cal lesion and the possibility to modulate the effect of stimulation by changing the stimulation parameters. The number of pati ents with implan- ted neuromodulation system in the pain treatment is substantially lower than the number of patients stimulated for Parkinson di sease. The most frequently used target structures for stereotactic neurostimulation for intractable pain are specific sensory thalamic nuclei a nd periaquaeductal/ periventricular gray matter. Stimulation of the posterior limb of internal capsule, hypothalamus, non specific thalamic nuclei and cingular gyrus is uncommon. The contemporary data show better effect of stereotactic neurostimulation on nociceptive than on neuropathic pain. Intracranial bleeding, infection and mechanical system violation are the most serious complications. It is important to underline the interd isciplinary chara- cter of intractable pain treatment with the leading role of pain specialists for indication of stereotactic surgery after the f ailure of contemporary elaborated effective medical treatment and various invasive techniques of pain treatment. |
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