부산대학교 도서관

Thalamic pain, which is primarily located in the face, is highly refractory, and there are few reports of effective medical and surgical treatments. Four months following a small infarction in the right thalamus, the patient felt severe burning pain on the left side of his face (V1–3 region, especially V2). The pain did not alleviate with medical treatment, and eventually operative treatment was performed at the urge of the patient. First, an electrode was inserted into the spinal epidural space of the superior cervical vertebrae to stimulate the trigeminal spinal nucleus. This test stimulus was only partly effective in that paresthesia was limited to an area from the mandible downward to the neck. Next, thalamotomy was planned, but no response was noted on stimulation of the face in response to somatotopy by electrical stimulation targeting the vicinity of the infarct lesion. After changing the target area to the small infarct lesion for reconstruction of the neural circuit and then performing coagulation, the patient's pain symptoms were dramatically ameliorated. This pain-relieving effect has persisted for more than two and a half years after the procedure.