• Motohiro Hayashi, Takaomi Taira, Taku Ochiai, Mikhail Chernov, Yuichi Takasu, Masahiro Izawa, Nobuo Kouyama, Mihoko Tomida, Osamu Tokumaru, Yoko Katayama, Yoriko Kawakami, Tomokatsu Hori, and Kintomo Takakura.
• Department of Neurosurgery, Neurological Institute, Graduate School of Medicine, Institute of Advanced Biomedical Technology & Science, Tokyo, Japan. GKRmoto@aol.com
• J. Neurosurg. 2005 Jan 1; 102 Suppl: 38-41.

ObjectAlthough reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain.MethodsInclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months.ConclusionsAn initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

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