Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain

Ido Strauss, Assaf Berger, Shlomit Ben Moshe, Michal Arad, Uri Hochberg, Tal Gonen, Rotem Tellem

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)400-408
Number of pages9
JournalStereotactic and Functional Neurosurgery
Volume95
Issue number6
DOIs
StatePublished - 1 Mar 2018

Keywords

  • Cingulotomy
  • Cognitive function
  • Intractable pain
  • Metastatic disease
  • Oncology
  • Pain relief
  • Palliative care

Fingerprint

Dive into the research topics of 'Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain'. Together they form a unique fingerprint.

Cite this