Posteromedial Hypothalamotomy for Behavioral Disturbances and Intractable Pain

  • Yoshiaki Mayanagi
  • Keiji Sano
Part of the Topics in neurological surgery book series (TINS, volume 1)


The hypothalamus, a continuation of the central periaqueductal gray matter, comprises the center of the neuroendocrine system; it surrounds the third ventricle with groups of neurons anteriorly and central gray matter posteriorly. The periventricular fibers, the medial forebrain bundle, and the dorsal longitudinal fasciculus are important fiber tracts that pass through the region. Relevant to the third ventricle because of its location, the posterior hypothalamus lies between the midcommissural point and the posterior commissure, below the anterior commissure-posterior commissure (AC — PC) line and includes the area 5–6 mm from the midline.


Behavioral Disturbance Intractable Pain Posterior Hypothalamus Periaqueductal Gray Matter Central Gray Matter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Akil H, Liebeskind JC: Monoaminergic mechanisms of stimulation-produced analgesia. Brain Res94: 279–296, 1975PubMedCrossRefGoogle Scholar
  2. 2.
    Akil H, Richardson DE, Hughes J, et al: Enkephalin-like material elevated in ventricular cerebrospinal fluid of pain patients after analgetic focal stimulation. Science 201: 463–465, 1978PubMedCrossRefGoogle Scholar
  3. 3.
    Balagura S, Raloh T: The analgesic effect of electrical stimulation of the diencephalon and mesencephalon. Brain Res 60: 369–379, 1973PubMedCrossRefGoogle Scholar
  4. 4.
    Balasubramaniam V, Kanaka TS: Amygdalotomy and hypothalamotomy—A comparative study. Confin Neurol 37: 195–201, 1975PubMedCrossRefGoogle Scholar
  5. 5.
    Ban T: The septo-preoptico-hypothalamic system and its autonomic function. In Tokizane T, Schade JP (eds): Progressive Brain Research Google Scholar
  6. 6.
    Black P. Uematsu S, Walker AE: Stereotaxic hypothalamotomy for control of violent aggressive behavior. Conlin Neurol 37: 187–188, 1975CrossRefGoogle Scholar
  7. 7.
    Carstens E: Inhibition of spinal horn neuronal responses to noxious skin heating by medial hypothalamic stimulation in the cat. J Neurophysiol 48: 808–822, 1982PubMedGoogle Scholar
  8. 8.
    Dafny N, Bental E, Feldman S: Effect of sensory stimuli on single unit activity in the posterior hypothalamus. Electroencephalogr Clin Neurophysiol19: 256–263, 1965PubMedCrossRefGoogle Scholar
  9. 9.
    Fairman D: Hypothalamotomy as a new perspective for alleviation of intractable pain and regression of metastatic malignant tumors. In Fusek I, Kunc Z (eds): Present Limits of Neurosurgery. Prague: Avicenum Czechoslovakian Medical Press, 1972, pp 525–528Google Scholar
  10. 10.
    Hess WR: Das Zwischenhirn. Syndrome, Lokalisationen, Funktionen. Basel: Schwabe, 1949Google Scholar
  11. 11.
    Hosobuchi Y, Rossier H, Bloom FE, et al: Stimulation of human periaqueductal gray for pain relief increases immunoreactive [3-endorphin in ventricular fluid. Science 203: 279–281, 1978CrossRefGoogle Scholar
  12. 12.
    Mayanagi Y, Hori T, Sano K: The posteromedial hypothalamus and pain-behavior, with special reference to endocrinological findings. Appl Neurophysiol 41: 223–231, 1978PubMedGoogle Scholar
  13. 13.
    Mayanagi Y, Sano K: Long-term follow-up results of the posteromedial hypothalamotomy. In Hitchcock ER, Ballantine HT Jr, Meyerson BA (eds): Modern Concepts in. Psychiatric Surgery. Amsterdam: Elsevier–North Holland Biomedical Press, 1979, pp 197–204Google Scholar
  14. 14.
    Mayanagi Y, Sano K, Suzuki I, et al: Stimulation and coagulation of the posteromedial hypothalamus for intractable pain, with reference to beta-endorphins. Appl Neurophysiol 45: 136–142, 1982PubMedGoogle Scholar
  15. 15.
    Mayanagi Y, Teramoto A, Hanamura T, et al: A study on stimulation producing analgesia in the hypothalamus and thalamus. In Tsubokawa T (ed): Brain Stimulation and Neural Plasticity. Tokyo: Neuron Press, 1985, pp 97–100Google Scholar
  16. 16.
    Mayer DJ, Liebeskind JC: Pain reduction by focal electrical stimulation of the brain: An anatomical and behavioral analysis. Brain Res 68: 73–93, 1974PubMedCrossRefGoogle Scholar
  17. 17.
    Oliveras JL, Guibaud G, Besson JM: A map of serotoninergic structures involved in stimulation producing analgesia in unrestrained freely moving cats. Brain Res 164: 317–322, 1979PubMedCrossRefGoogle Scholar
  18. 18.
    Oliveras JL, Hosobuchi Y, Guibaud G, et al: Analgesic electrical stimulation of the feline nucleus rephe magnus: Development of tolerance and its reversal by 5-HTP. Brain Res 146: 404–409, 1978PubMedCrossRefGoogle Scholar
  19. 19.
    Reynolds DV: Surgery in the rat during electri-cal analgesia induced by focal brain stimulation. Science 164: 444–445, 1969PubMedCrossRefGoogle Scholar
  20. 20.
    Richardson DE: Analgesia produced by stimulation of various sites in the human beta-endorphin system. Appl Neurophysiol 45: 116–122, 1982PubMedGoogle Scholar
  21. 21.
    Richardson DE, Akil H: Pain reduction by electrical brain stimulation in man. Part 1. Acute administration in periaqueductal and periventricular sites. J Neurosurg 47: 178–183, 1977PubMedCrossRefGoogle Scholar
  22. 22.
    Richardson DE, Akil H: Pain reduction by electrical brain stimulation in man. Part 2. Chronic self-administration in the periventricular gray matter. J Neurosurg 47: 184–194, 1977PubMedCrossRefGoogle Scholar
  23. 23.
    Rubio E, Arjona V, Rodriguez-Burgos F: Stereotactic cryohypothalamotomy in agressive behavior. In Sweet WH, et al (eds): Neurosurgical Treatment in Psychiatry, Pain and Epilepsy. Baltimore: University Park Press, 1977, pp 439–444Google Scholar
  24. 24.
    Sano K: Aggressiveness. In Schaltenbrand G, Walker AE (eds): Stereotaxy of the Human Brain. New York: Thieme-Stratton, 1982, pp 617–621Google Scholar
  25. 25.
    Sano K: Posterior hypothalamic lesions in the treatment of violent behavior. In Fields WS, Sweet WH (eds): Neural Bases of Violence and Aggression. St. Louis: WH Green, 1975, pp 401–420Google Scholar
  26. 26.
    Sano K: Sedative neurosurgery with special reference to posteromedial hypothalamotomy. Neurol Med Chir(Tokyo) 4: 112–142, 1962Google Scholar
  27. 27.
    Sano K: Sedative stereoencephalotomy: fornicotomy, upper mesencephalic reticulotomy and postero-medial hypothalamotomy. In Tokizane T, Schade JP (eds): Progressive Brain Research 21B. Amsterdam: Elsevier, 1966, pp 350–372Google Scholar
  28. 28.
    Sano K: Surgery of the hypothalamus—in commemoration of Otfrid Foerster. In Sano K, Ishii S (eds): Recent Progress in Neurological Surgery. Amsterdam: Excerpta Medica, 1974, pp 210–218Google Scholar
  29. 29.
    Sano K, Mayanagi Y, Sekino H, et al: Results of stimulation and destruction of the posterior hypothalamus in man. J Neurosurg 33: 689–707, 1970PubMedCrossRefGoogle Scholar
  30. 30.
    Sano K, Sekino H, Hashimoto T, et al: Posteromedial hypothalamotomy in the treatment of intractable pain. Confin Neurol 37: 285–290, 1975PubMedCrossRefGoogle Scholar
  31. 31.
    Sano K, Sekino H, Mayanagi Y: Results of stimulation and destruction of the posterior hypothalamus in cases with violent, aggressive or restless behavior. In Hitchcock E, et al (eds): Psychosurgery. Springfield, IL: Thomas, 1972, pp 57–75Google Scholar
  32. 32.
    Satoh M, Kawajiri S, Takagi H: Activation of dorsal hypothalamus-spinal dorsal horn descending inhibitory system by cyclazocine, an analgesic drug. In Fields HL, et al.(eds): Advances in Pain Research and Therapy, Vol 9. New York: Raven Press, 1985, pp 487–492Google Scholar
  33. 33.
    Schvarcz JR: Results of stimulation and destruction of the posterior hypothalamus: A longterm evaluation. In Sweet WH, et al (eds): Neurosurgical Treatment in Psychiatry, Pain and Epilepsy. Baltimore: University Park Press, 1977, pp 429–438Google Scholar
  34. 34.
    Schvarcz JR, Driollet R, Rios E, et al: Stereotactic hypothalamotomy for behavior disorders. J Neurol Neurosurg Psychiatry 35: 356–359, 1972PubMedCrossRefGoogle Scholar
  35. 35.
    Spiegel EA, Wycis HT, Freed H, et al: Thalamotomy and hypothalamotomy for treatment of psychoses: Psychiatric treatment. Res Publ Assoc Res Nery Ment Dis 31: 379–391, 1953Google Scholar
  36. 36.
    Sranja M, Nadvornik P: Surgical complication of posterior hypothalamotomy. Conlin Neurol 37: 193–194, 1975CrossRefGoogle Scholar
  37. 37.
    Tari A, Miyachi Y, Tanaka K, et al: Elevated immunoreactive f3-endorphin level in ventricular fluid after analgesic electrical stimulation of posteromedial hypothalamus. Endocrinol Jpn 30: 747–752, 1983PubMedCrossRefGoogle Scholar
  38. 38.
    Tokizane T, Kawamura H, Imamura G: Hypothalamic activation upon electrical activities of paleo-and archicortex. Neurol Med Chir(Tokyo) 2: 63–76, 1960CrossRefGoogle Scholar
  39. 39.
    Watanabe E, Mayanagi Y, Sano K: Influence of periaqueductal gray matter and posterior hypothalamic area on neuronal activity of the spinal dorsal horn. Brain Nerve(Jpn) 33: 1031-1036, 1981PubMedGoogle Scholar
  40. 40.
    Yoshioka M, Yoshimasu N, Yamada R, et al: Stereotactic posteromedial hypothalamotomy for relief of intractable pain. Neurol Med Chir(Tokyo) 12: 372–373, 1972Google Scholar
  41. 41.
    Yamada J, Otani K: The spinoperventricular fiber system in the rabbit, rat and cat. Exp Neurol 61: 395–406, 1978PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1988

Authors and Affiliations

  • Yoshiaki Mayanagi
  • Keiji Sano

There are no affiliations available

Personalised recommendations