Open AccessAnterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review
Author(s) -
Nader Pouratian
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2016.19.537
Subject(s) - medicine , chronic pain , adverse effect , systematic review , medline , physical therapy , political science , law
Background: Anterior cingulotomy for chronic pain aims to modulate patients’ attention oremotional reaction to pain rather than to modulate pain intensity.Objectives: To evaluate the clinical efficacy, both short- and long-term, of anterior cingulotomyin the treatment of chronic pain. Study Design: Systematic review.Setting: This systematic review assessed studies reporting anterior cingulotomy for the treatmentof chronic pain.Methods: A systematic search of Web of Science, Scopus, PubMed, and PsychINFO was performedusing both key words and controlled vocabulary. Articles included in this review included peerreviewed articles describing clinical outcomes or efficacy of cingulotomy in the treatment of chronicpain 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 procedureswere excluded, as were individual case reports. Results: A total of 11 articles encompassing 224 patients are included in the review, with ageranging 22 to 85 (mean: 56) years at the time of the operation, 59% of which were men. Greaterthan 60% of patients across all studies were reported to have significant pain relief post-operativelyas well as at one year after surgery. Common transient adverse effects included urinary incontinenceand confusion/disorientation, subsiding within days postoperatively. Serious/permanent adverseeffects included seizure in less than 5%, hemiparesis in less than 1%, and personality change inless than 1% of operations reported across all studies, all of which occurred primarily in operationswhere magnetic resonance (MR)-guidance was not used. Limitations: The limitations of this systematic review include the lack of studies other thanobservational reports and the inevitable heterogeneity between included studies.Conclusions: Despite decreased utilization in recent years, anterior cingulotomy is an effectiveneurosurgical intervention in the treatment of pain and carries little risk of permanent or seriousadverse effects.Key words: Anterior cingulotomy, chronic pain, stereotaxis, systematic review, pain, cingulategyrus, cingulotomy, intractable pain