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Bilateral Cingulotomy as a Therapeutic Option for Intractable Cancer Pain: a Systematic Review.

Saurabh Kataria^1,2, Jeremiah Hilkiah Wijaya³, Utsav Patel⁴

¹Departments of Interventional and Clinical Pain, Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, NM, 87131, USA.

Current Pain and Headache Reports

|December 28, 2025

Summary

Bilateral cingulotomy offers significant pain relief for patients with intractable cancer pain. This neurosurgical procedure demonstrates safety and efficacy, though further research is needed to standardize methods and long-term outcomes.

Keywords:

Cingulotomy Intractable cancer pain Pain management Radiofrequency ablation Stereotactic

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Area of Science:

Neurosurgery
Pain Management
Oncology

Background:

Cingulotomy targets the anterior cingulate cortex for refractory conditions.
Previous reviews focused on non-cancer pain, leaving a gap in cancer pain management.
Intractable cancer pain requires advanced palliative neurosurgical options.

Purpose of the Study:

Evaluate the efficacy and safety of bilateral cingulotomy for cancer-associated pain.
Address the underexplored role of neurosurgical palliation in cancer pain.
Provide evidence for bilateral cingulotomy in refractory cancer pain.

Main Methods:

Systematic review of six studies involving 172 patients.
Procedures utilized radiofrequency (RF) or radiofrequency ablation (RFA) lesioning.
Lesioning parameters: ~75-80°C for 60-80 seconds.

Main Results:

60-80% of patients experienced pain reduction.
Clinically meaningful pain improvement was consistently observed.
Low rates of transient cognitive or behavioral side effects were reported.
RFA-guided cingulotomy showed more precise lesioning and better short-term efficacy.

Conclusions:

Bilateral cingulotomy is a safe and promising intervention for intractable cancer pain.
Variations in methodology contribute to outcome heterogeneity.
Standardization, long-term neurocognitive monitoring, and multicenter data are recommended for future research.