Excellent Pain Relief Using Spinal Cord Stimulation Af- ter Failed Bilateral Stereotactic Anterior Cingulotomy in a Patient with Intractable Neuropathic Pain of the Lower Extremities Following Surgery of Tarlov Cysts
Nontaphon Piyawattanametha MD*, Bunpot Sitthinamsuwan MD, MSc**,***, Pramote Euasobhon MD***,****
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Siriraj Pain Management Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Neuropathic pain is a common consequence following disorder or injury of the nervous system. Neurosurgical
treatment is a proper option in patients with intractable neuropathic pain.
Objective : To report outcome of stereotactic bilateral anterior cingulotomy (SBAC) and spinal cord stimulation (SCS) in a
patient with intractable neuropathic pain.
Material and Method: A female patient suffered from intractable neuropathic pain on bilateral lower extremities after
multiple operations for Tarlov cysts and lysis of surrounding adhesions. The patient underwent SBAC and SCS.
Results : After SBAC, pain intensity assessed by visual analogue scale (VAS) was decreased from 9-10 of 10 to 0-1 of 10. The
patient could return to work and functional status was dramatically improved. Three months after SBAC, she developed
recurrent neuropathic pain. Second SBAC resulted in transient pain reduction. One year later, the patient underwent SCS after
an approval of reimbursement of expense for SCS equipment. After SCS, the VAS score was reduced from 8 of 10 to 0-1 of 10.
Excellent outcome was maintained until the present.
Conclusion : Both of SBAC and SCS yield good outcome in the treatment of intractable neuropathic pain. Recurrent pain may
occur after SBAC. Long-term pain relief can be maintained using SCS.
Keywords : Intractable neuropathic pain, Stereotactic bilateral anterior cingulotomy, Stereotactic surgery, Anterior cingulotomy, Spinal cord stimulation, Tarlov cyst, Perineural cyst
