Staged cingulotomy and capsulotomy for trigeminal neuropathic pain: A case report

Central lesioning techniques, such as cingulotomy and capsulotomy, have demonstrated efficacy in managing chronic pain, particularly in complex cases. These procedures are particularly useful for patients who are non-responsive to conventional treatments. The current study presents, to the best of our knowledge, the first case of a patient received combined stereotactic radiofrequency (RF) cingulotomy and GammaKnife capsulotomy (GKC), and who achieved good pain control after. The patient initially presented with severe, continuous left-sided facial pain unresponsive to medication and subsequently underwent a bilateral stereotactic RF cingulotomy. Pain levels were monitored using the Numeric Rating Scale. Patient satisfaction, as well as neurological and cognitive functions, were evaluated over a 2-year period. At 1-month post-cingulotomy, the patient's pain reduced from the initial score of 9/10 to 1/10, and the patient remained pain-free for the subsequent 3 months. Upon recurrence, the conducted GKC resulted in a more sustained reduction of pain to 2-3/10 at 1-year post-procedure. The patient reported high satisfaction with no observed neurological or cognitive deficits. Magnetic resonance imaging scans confirmed the presence of capsulotomy lesions in addition to the existing cingulotomy lesions. The combined cingulotomy and capsulotomy approach provided significant and sustained pain relief in the patient, indicating the potential of these techniques as advanced treatment options for refractory trigeminal neuropathic pain. This case is the first documented instance of the combined use of cingulotomy and capsulotomy, suggesting their viability for patients requiring higher-tier pain management strategies.