Roux F E, Ibarrola D, Lazorthes Y, Berry I
Department of Neurosurgery, H pital Rangueil, Toulouse, France.
Neurosurgery. 2001 Mar;48(3):681-7; discussion 687-8. doi: 10.1097/00006123-200103000-00050.
Chronic motor cortex stimulation has provided satisfactory control of pain in patients with central or neuropathic trigeminal pain. We used this technique in a patient who experienced phantom limb pain. Functional magnetic resonance imaging (fMRI) was used to guide electrode placement and to assist in understanding the control mechanisms involved in phantom limb pain.
A 45-year-old man whose right arm had been amputated 2 years previously experienced phantom limb pain and phantom limb phenomena, described as the apparent possibility of moving the amputated hand voluntarily. He was treated with chronic motor cortex stimulation.
Data from fMRI were used pre- and postoperatively to detect shoulder and stump cortical activated areas and the "virtual" amputated hand cortical area. These sites of preoperative fMRI activation were integrated in an infrared-based frameless stereotactic device for surgical planning. Phantom limb virtual finger movement caused contralateral primary motor cortex activation. Satisfactory pain control was obtained; a 70% reduction in the phantom limb pain was achieved on a visual analog scale. Postoperatively and under chronic stimulation, inhibiting effects on the primary sensorimotor cortex as well as on the contralateral primary motor and sensitive cortices were detected by fMRI studies.
Chronic motor cortex stimulation can be used to relieve phantom limb pain and phantom limb phenomena. Integrated by an infrared-based frameless stereotactic device, fMRI data are useful in assisting the neurosurgeon in electrode placement for this indication. Pain control mechanisms and cortical reorganization phenomena can be studied by the use of fMRI.
慢性运动皮层刺激已为中枢性或神经性三叉神经痛患者提供了令人满意的疼痛控制。我们将此技术用于一名幻肢痛患者。功能磁共振成像（fMRI）用于指导电极放置，并协助理解幻肢痛所涉及的控制机制。
一名45岁男性，其右臂在2年前被截肢，经历了幻肢痛和幻肢现象，表现为明显可自主移动已截肢手的可能性。他接受了慢性运动皮层刺激治疗。
术前和术后使用fMRI数据来检测肩部和残端的皮层激活区域以及“虚拟”已截肢手的皮层区域。术前fMRI激活的这些部位被整合到基于红外线的无框架立体定向设备中用于手术规划。幻肢虚拟手指运动引起对侧初级运动皮层激活。获得了满意的疼痛控制；视觉模拟评分显示幻肢痛减轻了70%。术后在慢性刺激下，fMRI研究检测到对初级感觉运动皮层以及对侧初级运动和感觉皮层的抑制作用。
慢性运动皮层刺激可用于缓解幻肢痛和幻肢现象。通过基于红外线的无框架立体定向设备整合，fMRI数据有助于神经外科医生针对此适应症进行电极放置。使用fMRI可研究疼痛控制机制和皮层重组现象。
