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 (World Health Organization 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.