Excellent Pain Relief Using Spinal Cord Stimulation After Failed Bilateral Stereotactic Anterior Cingulotomy in a Patient with Intractable Neuropathic Pain of the Lower Extremities Following Surgery of Tarlov Cysts

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.