Cingulotomy for Refractory Pain in Metastatic Clear Cell Sarcoma

Malignant pain is prevalent and often difficult to control. General management begins with the World Health Organization's analgesic guidelines and may further incorporate interventional techniques. For pain refractory to these measures, neuroablative procedures such as cingulotomy can be considered. We present the first known case of cingulotomy used in clear cell sarcoma.

A 22-year-old man with metastatic clear cell sarcoma of the thigh presented with debilitating bilateral lower extremity pain. Initial management consisted of aggressive systemic pharmacotherapy, radiotherapy, and ultimately the implantation of an intrathecal drug delivery system. Despite these interventions, his pain remained unremitting. He was therefore deemed a candidate for bilateral anterior cingulotomy, which was performed without complication. Postoperatively, the patient reported immediate pain relief, which allowed for significant functional improvement in the following weeks.

Cingulotomy can be an effective intervention in oncologic patients with diffuse pain that is refractory to conventional management.