Background: Stereotactic anterior cingulotomy has been used in the treatment of patients suffering from refractory oncological pain due to its effects on pain perception. However, the optimal targets as well as suitable candidates and outcome measures have not been well defined. We report our initial experience in the ablation of 2 cingulotomy targets on each side and the use of the Brief Pain Inventory (BPI) as a perioperative assessment tool. Methods: A retrospective review of all patients who underwent stereotactic anterior cingulotomy in our Department between November 2015 and February 2017 was performed. All patients had advanced metastatic cancer with limited prognosis and suffered from intractable oncological pain. Results: Thirteen patients (10 women and 3 men) underwent 14 cingulotomy procedures. Their mean age was 54 ± 14 years. All patients reported substantial pain relief immediately after the operation. Out of the 6 preoperatively bedridden patients, 3 started ambulating shortly after. At the 1-month follow-up, the mean preoperative Visual Analogue Scale score decreased from 9 ± 0.9 to 4 ± 2.7 (p = 0.003). Mean BPI pain severity and interference scores decreased from levels of 29 ± 4 and 55 ± 12 to 16 ± 12 (p = 0.028) and 37 ± 15 (p = 0.043), respectively. During the 1- and 3-month follow-up visits, 9/11 patients (82%) and 5/7 patients (71%) available for follow-up reported substantial pain relief. No patient reported worsening of pain during the study period. Neuropsychological analyses of 6 patients showed stable cognitive functions with a mild nonsignificant decline in focused attention and executive functions. Adverse events included transient confusion or mild apathy in 5 patients (38%) lasting 1-4 weeks. Conclusions: Our initial experience indicates that double stereotactic cingulotomy is safe and effective in alleviating refractory oncological pain.

1.
Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al: Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 2009;20:1420-1433.
[PubMed]
2.
van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J: Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 2007;18:1437-1449.
[PubMed]
3.
van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA: Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 2016;51:1070-1090.e9.
[PubMed]
4.
Caraceni A, Portenoy RK: An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain 1999;82:263-274.
[PubMed]
5.
Raslan AM: Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain. Neurosurgery 2008;62:226-233; discussion 233-234.
[PubMed]
6.
Harsh V, Viswanathan A: Surgical/radiological interventions for cancer pain. Curr Pain Headache Rep 2013;17:331.
[PubMed]
7.
Raslan AM, Cetas JS, McCartney S, Burchiel KJ: Destructive procedures for control of cancer pain: the case for cordotomy. J Neurosurg 2011;114:155-170.
[PubMed]
8.
Sharim J, Pouratian N: Anterior cingulotomy for the treatment of chronic intractable pain: a systematic review. Pain Physician 2016;19:537-550.
[PubMed]
9.
Viswanathan A, Harsh V, Pereira EAC, Aziz TZ: Cingulotomy for medically refractory cancer pain. Neurosurg Focus 2013;35:E1.
[PubMed]
10.
Russo JF, Sheth SA: Deep brain stimulation of the dorsal anterior cingulate cortex for the treatment of chronic neuropathic pain. Neurosurg Focus 2015;38:E11.
[PubMed]
11.
Wager TD, Atlas LY, Lindquist MA, Roy M, Woo C-W, Kross E: An fMRI-based neurologic signature of physical pain. N Engl J Med 2013;368:1388-1397.
[PubMed]
12.
Tracey I, Mantyh PW: The cerebral signature for pain perception and its modulation. Neuron 2007;55:377-391.
[PubMed]
13.
Apkarian AV: Pain perception in relation to emotional learning. Curr Opin Neurobiol 2008;18:464-468.
[PubMed]
14.
Peyron R, Laurent B, García-Larrea L: Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin 2000;30:263-288.
[PubMed]
15.
Dwolatzky T, Whitehead V, Doniger GM, Simon ES, Schweiger A, Jaffe D, Chertkow H: Validity of a novel cognitive battery for mild cognitive impairment. BMC Geriatr 2003;3:4.
[PubMed]
16.
Fallon MT, Cherny NI: Opioid therapy: optimizing analgesic outcomes; in Cherny N, Fallon M, Kaasa S, Portenoy R, Currow DC (eds): Oxford Textbook of Palliative Medicine, ed 5. Oxford, Oxford University Press, 2015, pp 525-559.
17.
Yen CP, Kung SS, Su YF, Lin WC, Howng SL, Kwan AL: Stereotactic bilateral anterior cingulotomy for intractable pain. J Clin Neurosci 2005;12:886-890.
[PubMed]
18.
Yen C-P, Kuan C-Y, Sheehan J, Kung S-S, Wang C-C, Liu C-K, et al: Impact of bilateral anterior cingulotomy on neurocognitive function in patients with intractable pain. J Clin Neurosci 2009;16:214-219.
[PubMed]
19.
Pillay PK, Hassenbusch SJ: Bilateral MRI-guided stereotactic cingulotomy for intractable pain. Stereotact Funct Neurosurg 1992;59:33-38.
[PubMed]
20.
Patel NV, Agarwal N, Mammis A, Danish SF: Frameless stereotactic magnetic resonance imaging-guided laser interstitial thermal therapy to perform bilateral anterior cingulotomy for intractable pain: feasibility, technical aspects, and initial experience in 3 patients. Neurosurgery 2015;11(suppl 2):17-25; discussion 25.
[PubMed]
21.
Cosgrove GR, Rauch SL: Stereotactic cingulotomy. Neurosurg Clin N Am 2003;14:225-235.
[PubMed]
22.
Sheth SA, Neal J, Tangherlini F, Mian MK, Gentil A, Cosgrove GR, et al: Limbic system surgery for treatment-refractory obsessive-compulsive disorder: a prospective long-term follow-up of 64 patients. J Neurosurg 2013;118:491-497.
[PubMed]
You do not currently have access to this content.