Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review.

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.