Stereotactic bilateral anterior cingulotomy for intractable pain

Yen, Chun Po; Kung, Sui Sum; Su, Yung‐Yeh; Lin, Wei Chen; Howng, Shen Long; Kwan, Andy C.C.

doi:10.1016/j.jocn.2004.11.018

Cited by 83 publications

(54 citation statements)

References 25 publications

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“…This was accompanied by a decrease in opioid consumption immediately after surgery. Reports using modern MRI-guided stereotactic techniques are limited to small case series [17,18,19,20]. Despite the difficulty in comparing results of small series, our results are in the range of previously published series.…”

Section: Discussionmentioning

confidence: 63%

“…Despite the difficulty in comparing results of small series, our results are in the range of previously published series. The most recent series were published by Yen et al [17,18] in 2005 and 2009, who reported their results in 2 series of 15 and 10 cancer patients, respectively. They reported significant pain reduction in 60-80% of the patients at 1 month, which dropped to 55% at 3 months and 50% at 6 months.…”

Section: Discussionmentioning

confidence: 99%

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Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain

Strauss¹,

Berger²,

S³

et al. 2017

Stereotact Funct Neurosurg

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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.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain

Strauss¹,

Berger²,

S³

et al. 2017

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

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“…ACC has been reported to be activated in different chronic pain conditions (Apkarian et al, 2005;Zhuo, 2008Zhuo, , 2011. Inactivation of the ACC, by surgical lesions or cell death caused by stroke, leads to the reduction of the unpleasantness of pain or reduced pain intensity (Pillay and Hassenbusch, 1992;Wong et al, 1997;Yen et al, 2005Yen et al, , 2009. Electrophysiological recording from human shows that many ACC neurons are indeed nociceptive (Hutchison et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Plasticity of Metabotropic Glutamate Receptor-Dependent Long-Term Depression in the Anterior Cingulate Cortex after Amputation

et al. 2012

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Long-term depression (LTD) is a key form of synaptic plasticity important in learning and information storage in the brain. It has been studied in various cortical regions, including the anterior cingulate cortex (ACC). ACC is a crucial cortical region involved in such emotion-related physiological and pathological conditions as fear memory and chronic pain. In the present study, we used a multielectrode array system to map cingulate LTD in a spatiotemporal manner within the ACC. We found that low-frequency stimulation (1 Hz, 15 min) applied onto deep layer V induced LTD in layers II/III and layers V/VI. Cingulate LTD requires activation of metabotropic glutamate receptors (mGluRs), while L-type voltage-gated calcium channels and NMDA receptors also contribute to its induction. Peripheral amputation of the distal tail impaired ACC LTD, an effect that persisted for at least 2 weeks. The loss of LTD was rescued by priming ACC slices with activation of mGluR1 receptors by coapplying (RS)-3,5-dihydroxyphenylglycine and MPEP, a form of metaplasticity that involved the activation of protein kinase C. Our results provide in vitro evidence of the spatiotemporal properties of ACC LTD in adult mice. We demonstrate that tail amputation causes LTD impairment within the ACC circuit and that this can be rescued by activation of mGluR1.

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“…3,13 Yen et al 13 evaluated a total of 15 patients who were followed over time to identify signs of pain recurrence or no relief in patients who underwent RF-guided cingulatomy for pain management. Evaluation of a patient's response to treatment was performed at regular intervals (1 week, 3 months, and 6 months, and 1 year post-treatment).…”

Section: Previous Work and Novel Contributionsmentioning

confidence: 99%

Association of computerized texture features on MRI with early treatment response following laser ablation for neuropathic cancer pain: preliminary findings

et al. 2015

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Abstract. Laser interstitial thermal therapy (LITT) has recently emerged as a new treatment modality for cancer pain management that targets the cingulum (pain center in the brain) and has shown promise over radio frequency (RF)-based ablation, due to magnetic resonance image (MRI) guidance that allows for precise ablation. Since laser ablation for pain management is currently exploratory and is only performed at a few centers worldwide, its short-and long-term effects on the cingulum are currently unknown. Traditionally, treatment effects for neurological conditions are evaluated by monitoring changes in intensities and/or volume of the ablation zone on post-treatment Gadolinium-contrast T1-w (Gd-T1) MRI. However, LITT introduces subtle localized changes corresponding to tissues response to treatment, which may not be appreciable on visual inspection of volumetric or intensity changes. Additionally, different MRI protocols [Gd-T1, T2w, gradient echo sequence (GRE), fluidattenuated inversion recovery (FLAIR)] are known to capture complementary diagnostic information regarding the patient's response to treatment; the utility of these MRI protocols has so far not been investigated to evaluate early and localized response to LITT treatment in the context of neuropathic cancer pain. In this work, we present the first attempt at (a) examining early treatment-related changes on a per-voxel basis via quantitative comparison of computer-extracted texture descriptors across pre-and post-LITT multiparametric (MP-MRI) (Gd-T1, T2w, GRE, FLAIR), subtle microarchitectural texture changes that may not be appreciable on original MR intensities or volumetric differences, and (b) investigating the efficacy of different MRI protocols in accurately capturing immediate post-treatment changes reflected (1) within and (2) outside the ablation zone. A retrospective cohort of four patient studies comprising pre-and immediate (24 h) post-LITT 3 Tesla Gd-T1, T2w, GRE, and FLAIR acquisitions was considered. Our quantitative approach first involved intensity standardization to allow for grayscale MR intensities acquired pre-and post-LITT to have a fixed tissue-specific meaning within the same imaging protocol, the same body region, and within the same patient. An affine registration was then performed on individual post-LITT MRI protocols to a reference MRI protocol pre-LITT. A total of 78 computerized texture features (co-occurrence matrix homogeneity, neighboring gray-level dependence matrix, Gabor) are then extracted from pre-and post-LITT MP-MRI on a per-voxel basis. Quantitative, voxelwise comparison of the changes in MRI texture features between pre-and post-LITT MRI indicate that (a) Gabor texture features at specific orientations were highly sensitive as well as specific in predicting subtle microarchitectural changes within and around the ablation zone pre-and post-LITT, (b) FLAIR was identified as the most sensitive MRI protocol in identifying early treatment changes yielding a normalized percentage change of 360% within the ablat...

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Stereotactic bilateral anterior cingulotomy for intractable pain

Cited by 83 publications

References 25 publications

Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain

Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain

Plasticity of Metabotropic Glutamate Receptor-Dependent Long-Term Depression in the Anterior Cingulate Cortex after Amputation

Association of computerized texture features on MRI with early treatment response following laser ablation for neuropathic cancer pain: preliminary findings

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