gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Stereotactic Deep Brain Modulation targeting the somatosensory and affective pain circuits of the thalamus

Stereotaktische Modulation der somatosensorischen und affektiven Schmerzverarbeitung des Thalamus

Meeting Abstract

  • presenting/speaker Thomas Kinfe - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Division Functional Neurosurgery and Stereotaxy, Erlangen, Deutschland
  • Martin Nüssel - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
  • Andreas Stadlbauer - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
  • Yining Zhao - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
  • Michael Buchfelder - Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV321

doi: 10.3205/22dgnc308, urn:nbn:de:0183-22dgnc3087

Veröffentlicht: 25. Mai 2022

© 2022 Kinfe et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Despite tremendous advances in drug and physical therapy, chronic pain treatment remains challenging in a considerable proportion of individuals. When conventional therapies fail, modulation of the lateral and medial thalamic pain networks (Figure 1 [Fig. 1]) using reversible deep brain stimulation (DBS) or targeted irreversible thalamotomy by Gamma Knife Radiosurgery (GKRS), Radiofrequency ablation (RFA) or Magnetic Resonance (MR)-guided Focus Ultrasound (MRgFUS) appear to be considerable treatment options.

Methods: We performed a literature search for clinical trials targeting the sensory and affective thalamic circuits relevant for pain processing. We performed databased searches and a manual library search was performed using the terms “chronic pain”, “thalamotomy”, “deep brain stimulation”, “ventral-postero-lateral nucleus of the thalamus”, “centrum-median parafascicular nucleus of the thalamus”, “affective thalamic pain transmission”, “somatosensory thalamic pain processing”, and “anterior cingulate cortex” (Figure 2 [Fig. 2]).

Results: We identified in-human studies targeting the somatosensory and affective thalamic nuclei for four different stereotactic-guided procedures, namely DBS, GKRS, RFA, MRgFUS. Specifically, we identified a total number of 320 patients that has been treated with thalamic DBS indicating thalamic DBS to be effective and safe. Furthermore, DBS of the anterior cingulate cortex (ACC), a target associated with the affective pain domain, revealed 5 human studies with a total of 54 implanted chronic pain patients. GKRS was performed in a total of 60 patients, while MRgFUS has been applied to a relatively low number of patients.

Conclusion: VPL and CmPf DBS decreased pain by sensory and attentional modulation. Chronic pain stimulated in the CmPf or ACC reported unchanged pain levels, however, affective distancing to chronic pain stimuli was observed in these cohorts of DBS patients (Figure 1 a [Fig. 1]). However, the available data is of heterogeneous and of preliminary nature, hindering effective comparable analysis. Hence, recommendations and guidelines covering advantages and disadvantages of each approach, including such parameters as invasiveness, risk-benefit ratio, reversibility and responsiveness are warranted.