Ito Masaki, Kuroda Satoshi, Takano Kazuya, Maruichi Katsuhiko, Chiba Yasuhiro, Morimoto Yuji, Iwasaki Yoshinobu
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan.
No Shinkei Geka. 2006 Sep;34(9):919-24.
Although motor cortex stimulation (MCS) has been accepted as an effective therapeutic option for central pain, the efficacy of MCS widely varies among previous reports. In this report, we describe our recent trial for successful MCS in 3 patients with central pain due to cerebral stroke. Medical treatments were transiently effective, but gradually became ineffective in all of the cases. During surgery, the appropriate cortical target was determined by using neuronavigation, somatosensory evoked potential (SEP), and motor evoked potential (MEP). A flat, four-plate electrode was positioned on the dura mater parallel to the motor cortex. After surgery, pain almost resolved in 2 of 3 patients and markedly improved in another. The pain relief depended on their motor function. These findings strongly suggest that both patient selection and intraoperative monitoring for targeting the motor cortex are quite important for successful MCS, although further studies were essential.
尽管运动皮层刺激（MCS）已被公认为是治疗中枢性疼痛的一种有效方法，但在以往的报告中，MCS的疗效差异很大。在本报告中，我们描述了我们最近对3例因脑卒 中导致中枢性疼痛患者成功进行MCS的试验。药物治疗曾有短暂疗效，但在所有病例中逐渐失效。手术过程中，通过使用神经导航、体感诱发电位（SEP）和运动诱发电位（MEP）来确定合适的皮层靶点。将一个扁平的四板电极平行于运动皮层放置在硬脑膜上。术后，3例患者中有2例疼痛几乎完全缓解，另1例明显改善。疼痛缓解取决于他们的运动功能。这些发现强烈表明，尽管进一步的研究必不可少，但患者选择和术中针对运动皮层的监测对于成功进行MCS非常重要。
