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BACKGROUND: Stereotactic central lateral thalamotomy (CLT) has been applied as a treatment for chronic intractable neuropathic pain. However, it is not clear whether this intervention influences the emotional and cognitive impairments observed in patients who have chronic neuropathic pain. OBJECTIVE: To investigate neuropsychological functions and emotional processing in patients with chronic neuropathic pain compared with healthy volunteers and to explore the neuropsychiatric effect of the CLT. METHODS: We investigated pain ratings, cognitive functions, emotional processes, and personality variables before and after surgery in 8 patients with intractable neuropathic pain. Patients were tested before and 3 months after CLT by the use of neuropsychological tests; clinical scales for depression, anxiety, anhedonia, and anger regulation; a personality test; and 2 experimental tasks testing the theory of mind as well as the ability to recognize facial emotional expressions. Nine age- and sex-matched control subjects were tested once using the same procedure. RESULTS: The comparison of the patient group before surgery with the control group evidenced significant differences on the cognitive assessments, the depression and anxiety scores, as well as on the somatic complaint subscale of the personality test. Three months after CLT, patients experienced a significant improvement in their depression scores. There were no additional postsurgical cognitive impairments. CONCLUSION: For our patients with chronic neuropathic pain, CLT provided pain relief and reduction of their depression scores without causing postsurgical cognitive impairments.

Objective The aim of this work was to provide a detailed description of the arterial vascularization of the temporomesial region (TMR), correlated with the definitions of the macroscopic and cytoarchitectonic subdivisions of this area. Methods Selective colored arterial injections were performed in 16 hemispheres to study their blood supply. Four hemispheres were used to illustrate the macroscopic aspect of the TMR and were then cut into thin sections and stained with Nissl's stain to study the cytoarchitectonic areas. Results The surface of the TMR is subdivided into several areas: anteriorly, the lateral olfactory gyrus is covered by prepiriform cortex; dorsomedially, the semilunar gyrus and uncus hippocampi consist, respectively, of cortical amygdaloid nucleus and hippocampal cytoarchitectonic fields; and ventrolaterally, the anterior part of the parahippocampal gyrus is covered by periamygdaloid cortex, entorhinal, and transentorhinal areas and its posterior part is covered by Fields TH and TF per Von Economo and subicular complex. Six cortical arterial groups were defined: Group I, anterosuperior parahippocampal arteries (mean, 3.9 arteries) vascularize the ambiens, semilunar, and lateral olfactory gyri (origins: middle cerebral artery, anterior choroidal artery [AChA], posterior cerebral artery [PCA], and internal carotid artery); Group II, anteroinferior parahippocampal arteries (mean, 2.8 arteries) irrigate the anterior ventrolateral region of the parahippocampal gyrus (origins: middle cerebral artery, PCA, and AChA); Group III, medial uncal arteries (mean, 1.9 arteries) supply the medial part of uncus hippocampi (origins: AChA and PCA); Group IV, lateral uncal arteries (mean, 2.9 arteries) vascularize the lateral part of the uncus hippocampi (origins: AChA and PCA); Group V, several small posterior parahippocampal arteries irrigate Fields TF and TH per Von Economo (origins: PCA and AChA); and Group VI, posterior hippocampal arteries (mean, 3.2 arteries) irrigate the posterior part of hippocampal formation (origin: PCA). Many anastomoses are found among these arteries, particularly in the ventrolateral part of the TMR. Three groups of amygdaloid arteries were defined: Group I, the anterolateral group (mean, 5.7 arteries) (origin: middle cerebral artery); Group II, the medial group (mean, 6.4 arteries) (origins: AChA, internal carotid artery, and PCA); and Group III, the posterolateral group (mean, 5 arteries) (origins: AChA and internal carotid artery). Conclusion We hope that this work will be useful for any microneurosurgical procedures on the TMR. We have clarified the macroscopic and histological definitions of the cortical and nuclear areas of the TMR and the arterial groups closely related to them. The systematic analysis of the variability of the arterial vascularization of this area was our second goal; such a goal, however, requires more observations to be exhaustive. The numerous interterritorial anastomoses found inside the TMR imply that a selective presurgical injection of short-acting barbiturates to evaluate its functions (Wada test) may well result in its diffusion to other areas of the TMR.

The authors report on a series of 53 bedridden patients suffering from harmful spasticity in one (6) or both (47) lower limbs, who were treated with microsurgical DREZ-otomy. Surgery was performed to treat fixed abnormal postures in flexion in 49 patients and hyperextension in 3, and, additionally, to treat pain in 37 patients. Microsurgical DREZ-otomy was introduced in 1972, on the basis of anatomical studies of the human dorsal root entry zone (DREZ) showing a topographical segregation of the afferent fibers according to their size and functional destinations. It consists of a 2 mm deep microsurgical lesion directed at a 45° angle in the posterolateral sulcus and penetrating the dorsal root entry zone in its ventrolateral aspect, at the level of all the rootlets considered involved in spasticity (and pain). It destroys mainly the lateral (nociceptive) and central (myotatic) afferent fibers as well as the facilitatory medial part of the Lissauer tract, while sparing most of the medial (lemniscal) fibers, the suppressor lateral part of the Lissauer tract, and more or less of the dorsal horn (DH). The postoperative results were evaluated after a mean follow-up period of 3 years and 4 months. Both spasticity and spasms were significantly decreased or suppressed in 75% and 88.2% of the patients, respectively. When present, pain was relieved without abolition of sensation in 91.6%. These benefits-combined with complementary orthopedic surgery in 23 patients-resulted in either disappearance or marked reduction of the abnormal postures in 85.3% of the patients and of articular limitations in 96.8%. Mid-to-severe complications occurred in 25 patients and precipitated or were responsible for death in 5. This is explained by the fact that the general and neurological conditions of most of the patients-especially those affected by multiple sclerosis-were precarious. MDT has, however, enabled a majority of these severely disabled patients to sit and lie comfortably, and has allowed them to reach a significantly improved quality of life.