Outcome After Pituitary Radiosurgery for Thalamic Pain Syndrome

Motohiro Hayashi, Mikhail F. Chernov, Takaomi Taira, Taku Ochiai, Kotaro Nakaya, Noriko Tamura, Shinichi Goto, Shoji Yomo, Nobuo Kouyama, Yoko Katayama, Yoriko Kawakami, Masahiro Izawa, Yoshihiro Muragaki, Ryoichi Nakamura, Hiroshi Iseki, Tomokatsu Hori, Kintomo Takakura

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    14 Citations (Scopus)

    Abstract

    Purpose: To evaluate outcomes after pituitary radiosurgery in patients with post-stroke thalamic pain syndrome. Methods and Materials: From 2002 to 2006, 24 patients with thalamic pain syndrome underwent pituitary radiosurgery at Tokyo Women's Medical University and were followed at least 12 months thereafter. The radiosurgical target was defined as the pituitary gland and its connection with the pituitary stalk. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was 35 months (range, 12-48 months). Results: Initial pain reduction, usually within 48 h after radiosurgery, was marked in 17 patients (71%). However, in the majority of cases the pain recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 5 patients (21%). Ten patients (42%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 1, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once. Conclusions: Pituitary radiosurgery for thalamic pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. It can be used as a primary minimally invasive management option for patients with post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases pain recurrence occurs within 1 year after treatment.

    Original languageEnglish
    Pages (from-to)852-857
    Number of pages6
    JournalInternational Journal of Radiation Oncology Biology Physics
    Volume69
    Issue number3
    DOIs
    Publication statusPublished - 2007 Nov 1

    Keywords

    • Gamma Knife radiosurgery
    • Outcome
    • Pituitary irradiation
    • Thalamic pain syndrome
    • Treatment

    ASJC Scopus subject areas

    • Radiation
    • Oncology
    • Radiology Nuclear Medicine and imaging
    • Cancer Research

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  • Cite this

    Hayashi, M., Chernov, M. F., Taira, T., Ochiai, T., Nakaya, K., Tamura, N., Goto, S., Yomo, S., Kouyama, N., Katayama, Y., Kawakami, Y., Izawa, M., Muragaki, Y., Nakamura, R., Iseki, H., Hori, T., & Takakura, K. (2007). Outcome After Pituitary Radiosurgery for Thalamic Pain Syndrome. International Journal of Radiation Oncology Biology Physics, 69(3), 852-857. https://doi.org/10.1016/j.ijrobp.2007.04.043