Kollenburg Linda, Kurt Erkan, Arnts Hisse, Vinke Saman
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Donders Center for Brain, Cognition and Behaviour, Department of Neurosurgery.
Pain Rep. 2024 Mar 22;9(2):e1149. doi: 10.1097/PR9.0000000000001149. eCollection 2024 Apr.
Central poststroke pain (CPSP) places a huge burden on patient lives because patients are often refractory to conventional strategies and have little chance for spontaneous recovery. A subset of patients is even given approval for euthanasia and is without any perspective. Because the anterior cingulate cortex historically seems to be a promising target for patients with both mental and chronic pain disorders, lesioning of this central "hub" with cingulotomy may be a useful strategy for medically refractory CPSP. However, limited research is available on cingulotomy for central pain. Hence, we represent a rare case in which cingulotomy is performed on a patient with CPSP.
To describe the potential of cingulotomy in a case with CPSP.
The case presented in this study concerns a 60-year-old woman who experienced CPSP, caused by a hemorrhagic stroke in the basal ganglia and thalamus. The patient visited several centers and tried multiple off-label treatments; however, she was told nothing else could be done and was even given approval for euthanasia. Hence, anterior cingulotomy was performed.
After surgery, no transient adverse events occurred, except for vocabulary disturbances post stroke, which disappeared after several weeks. After 14 weeks, changes in pain behavior were observed, followed by a decreased pain intensity. At a later follow-up, the pain had completely disappeared.
Anterior cingulotomy seems to be a suitable "last-resort" option for patients with CPSP. Future research, including homogenous groups, to define the best location for lesioning is required to allow the revival of this "old" technique in the current era.
中风后中枢性疼痛（CPSP）给患者的生活带来了巨大负担，因为患者通常对传统治疗方法无效，且几乎没有自发恢复的机会。一部分患者甚至被批准安乐死，毫无希望可言。由于前扣带回皮质在历史上似乎是治疗精神和慢性疼痛障碍患者的一个有前景的靶点，通过扣带回切开术损伤这个中枢“枢纽”可能是治疗药物难治性CPSP的一种有用策略。然而，关于扣带回切开术治疗中枢性疼痛的研究有限。因此，我们报告了一例对CPSP患者进行扣带回切开术的罕见病例。
描述扣带回切开术在一例CPSP患者中的潜力。
本研究中的病例是一名60岁女性，患有由基底节和丘脑出血性中风引起的CPSP。该患者就诊于多个中心并尝试了多种非标签治疗；然而，她被告知别无他法，甚至被批准安乐死。因此，进行了前扣带回切开术。
手术后，除了中风后出现的词汇障碍，几周后消失外，没有发生短暂的不良事件。14周后，观察到疼痛行为有变化，随后疼痛强度降低。在后来的随访中，疼痛完全消失。
前扣带回切开术似乎是CPSP患者合适的“最后手段”选择。需要开展包括同质组在内的未来研究，以确定最佳的损伤位置，从而使这种“古老”技术在当今时代得以复兴。
