A Case of Anterior Cingulotomy for Intractable Pain Caused Thalamic Glioma.

Abstract

Stereotactic bilateral anterior cingulotomy, including lesions in the anterior and midcingulate cortex, is one of the methods used for treating thalamic pain syndrome. In cases of non-ischemic thalamic lesions, simultaneous stereotactic biopsy of the lesion can be performed in combination with cingulotomy. In this paper we present a case of a 45-year-old male with a lesion in the right thalamus, causing a severe contralateral hemi-pain syndrome. Bilateral radiofrequency anterior cingulotomy and stereotactic biopsy were performed during a single surgery. Pain completely subsided within a few days following the anterior cingulotomy. Histological examination identified a diffuse astrocytoma (WHO grade II, ICD-O 9400/3), and the patient was subsequently referred for LINAC-based radiosurgery. The pain syndrome was controlled for 4 years, after which the pain syndrome returned with an increase in tumor size. Simultaneous anterior cingulotomy and stereotactic biopsy of the thalamic lesion represent a safe intervention for thalamic pain syndrome, enabling the alleviation of pain, verification of the lesion's etiology, and the application of appropriate treatment.