Vol 2. N°3. 2007  |  Noviembre de 2007



Dres. Pablo Hernández, Fernando Martínez, María José Montes, Irene Retamoso
(Pág. 196)


Clinical case: In this article we describe the case of a 40 years old patient who suffered a subarachnoid hemorrhage. For this reason the patient underwent surgery, procedure in which an aneurism of the left middle cerebral artery (MCA) was clipped in 1998. Posteriorly, the patient suffered an ischemic event secondary to vasospasm in the territory of the mentioned artery. He had a good evolution, with only a mild motor deficit on the right extremities as a remaining symptom, and was able to resume his daily life and retake his job. One year after the event he starts feeling an intense sharp pain over the right hemi body, involving all the face and the upper extremity. In the initial time, he partially responded to medical treatment but rapidly became resistant. The evolution of his condition also included a depressive component, with four suicide attempts, reason for which he was under treatment with a psychiatric. The refractory nature of the condition leads us to evaluate the necessity of a neurosurgical treatment. Given the scenario of thalamic hiperpathy, and overlapped by severe depression, the decision was to perform a bilateral anterior cingulotomy.

Results: The patient had a good evolution with an evident relief of pain and improvement of his depression, and he was reincorporated to his job one year after the surgery.

Conclusions: In a case of thalamic pain refractory to conservative treatment, and overlapped by severe depression that puts in risk the patient's life, a surgical option to be considered is the bilateral anterior cingulotomy, since its efficacy has been demonstrated for both conditions.

PALABRAS CLAVE: cingulotomía; dolor talámico; depresión; estereotaxia; neurocirugía funcional