ABSTRACT
Deep Brain Stimulation(DBS) analgesia is known to be an effective method of otherwise intractable chronic pain. The authors report a case of thalamic DBS for the relief of recurred deafferentation pain after DREZotomy. The patient was a 53-year-old female who had presented with neuropathic pain on right shoulder and upper extremity, owing to previous brachial plexus injury. She underwent DREZotomy on C3-C5 level with resultant pain relief, but symptom recurred 3 months after surgery. The authors performed left VPL nucleus stimulation, and good relief of the pain was achieved. We reviewed the pertinent literature, and discussed pathophysiology, clinical result of the DBS on deafferentation pain.
Subject(s)
Female , Humans , Middle Aged , Analgesia , Brachial Plexus , Brain , Causalgia , Chronic Pain , Deep Brain Stimulation , Neuralgia , Shoulder , Upper ExtremityABSTRACT
Treatment of pain related to various types of deafferentation remains a neurosurgical challenge. Medical therapy and conventional surgical techniques for pain relief have not been effective due to this problem. Six patients with intractable pain following a brachial plexus injury were treated with dorsal root entry zone(DREZ) lesions. These lesions were made with CO2 laser. All patients were followed from 5 months to 5 years after surgery. Two-third of the patients were relieved of more than 50% of their preoperative pain. Post-operative neurosurgical complications were ipsilateral leg weakness and loss of proprioception in 2 cases. The laser technique is exact, makes uniform lesion, shortens the duration of the procedure, lessens cord manipulation and makes shalow penetration into the surrounding spinal cord. Dorsal root entry zone(DREZ) lesions made with CO2 laser appeared to be a satisfactory treatment for brachial plexus injury patients who have failed to respond to more conservative modes of therapy.
Subject(s)
Humans , Brachial Plexus , Causalgia , Lasers, Gas , Leg , Pain, Intractable , Proprioception , Spinal Cord , Spinal Nerve RootsABSTRACT
It is well documented that dorsal root entry zone(DREZ) lesions were good method to control intractable chronic deafferentation pain of spinal origin which was not controlled with various medical and surgical treatment. Experience with radiofrequency lesions of dorsal root entry zone in 3 of patients with post herpetic pain and 1 of patient with post amputation pain are reported. The follow-up period ranging from 3-20 months and all patients obtained satisfactory pain relief.