Treatment of Intractable Cancer Pain by Stereotactic Bilateral Anterior Cingulotomy.

Jung, Jin Young; Chang, Jong Hee; Chang, Jin Woo; Park, Yong Gou; Chung, Sang Sup

Original Article

Journal of Korean Neurosurgical Society 2001;30(4): 456-462.

Jin Young Jung, Jong Hee Chang, Jin Woo Chang, Yong Gou Park, Sang Sup Chung

¹Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
²Department of Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

OBJECTIVE
Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain.
METHOD
Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex.
Result
In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure.
CONCLUSION
These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

Key Words: Cancer pain; Cingulate cortex; Cingulotomy; Opioid