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Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review
Justin Sharim1, Nader Pouratian2
1Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Background:
Anterior cingulotomy for chronic pain aims to modulate patients' attention or emotional reaction to pain rather than to modulate pain intensity.
Objectives:
To evaluate the clinical efficacy, both short- and long-term, of anterior cingulotomy in the treatment of chronic pain.
Study Design:
Systematic review.
Setting:
This systematic review assessed studies reporting anterior cingulotomy for the treatment of chronic pain.
Methods:
A systematic search of Web of Science, Scopus, PubMed, and PsychINFO was performed using both key words and controlled vocabulary. Articles included in this review included peer-reviewed articles describing clinical outcomes or efficacy of cingulotomy in the treatment of chronic pain with minimum follow-up of 3 months for non-malignant and 2 weeks for malignant pain. Articles reporting cingulectomies or cingulotomy only as combined with other ablative procedures were excluded, as were individual case reports.
Results:
A total of 11 articles encompassing 224 patients are included in the review, with age ranging 22 to 85 (mean: 56) years at the time of the operation, 59% of which were men. Greater than 60% of patients across all studies were reported to have significant pain relief post-operatively as well as at one year after surgery. Common transient adverse effects included urinary incontinence and confusion/disorientation, subsiding within days postoperatively. Serious/permanent adverse effects included seizure in less than 5%, hemiparesis in less than 1%, and personality change in less than 1% of operations reported across all studies, all of which occurred primarily in operations where magnetic resonance (MR)-guidance was not used.
Limitations:
The limitations of this systematic review include the lack of studies other than observational reports and the inevitable heterogeneity between included studies.
Conclusions:
Despite decreased utilization in recent years, anterior cingulotomy is an effective neurosurgical intervention in the treatment of pain and carries little risk of permanent or serious adverse effects.Key words: Anterior cingulotomy, chronic pain, stereotaxis, systematic review, pain, cingulate gyrus, cingulotomy, intractable pain.
