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Cingulotomy is a treatment option for patients with treatment resistant pain. Unlike other pain procedures that aim to interrupt the pain signal itself, cingulotomy targets the “affective” component of pain. The affective component is the suffering and emotional component of pain, and the goal of this surgery is to reduce it. Although it is one of the more invasive procedures done for pain, it can provide significant relief. It can also ensure that the amount of pain medication required is reduced, which offers the additional benefit of decreasing the chance of medication-related side effects.
How Does a Cingulotomy Work?
Pain signals enter the spinal cord, climb up to the brain, and are eventually associated with emotions – usually of suffering. The goal of this surgery is to interrupt the emotional and suffering component of chronic pain.
The area of the brain treated during a cingulotomy is called the anterior cingulate region. This is an aspect of the limbic system, which assists in responding to emotion. The anterior cingulate region is associated with regulating emotions and feelings related to chronic pain.
During the surgery, a very precise probe is targeted to the anterior cingulate region and a very precise lesion is made in the brain on each side. Specialized monitoring of the brain is used throughout to maximize the safety of the procedure.
A cingulotomy avoids any need for maintenance procedures and does not involve any implants or implant replacement.
Am I A Good Candidate?
Patients who want to live a life free from chronic intense pain are excellent candidates for a cingulotomy procedure. In order to be a good candidate, patients must have experienced chronic pain for six months or more.
Cingulotomy has been used both for malignant pain (pain related to cancer) and non-malignant pain. Non-malignant causes of pain can include chronic neuropathic facial pain, for which there are few other treatments. Cingulotomy is relatively indiscriminate in the types of pain it can help, but it may be particularly helpful when there is a strong emotional burden related to the pain.
Typically, patients with spinal cord trauma, atypical types of chronic facial pain or trigeminal neuralgia, and post-stroke chronic pain find this procedure to be helpful.
Patients who have exhausted all non-surgical options, including medical procedures and therapies, are ideal candidates for cingulotomy surgery, since this procedure cannot be reversed. Candidates must be healthy enough to undergo the procedure.
Patients with brain lesions are not recommended for cingulotomy. Additionally, patients who have cognitive issues or personality disorders like sociopathic personality are not good candidates.
Your Cingulotomy Consultation
During your consultation, Dr. Pouratian will evaluate the intensity of your pain and the main cause of your pain. He will evaluate your medical history and conduct a detailed physical exam. It is necessary to tell Dr. Pouratian about any medications, supplements, or treatments you have tried or are currently using for pain relief.
After the doctor determines that cingulotomy surgery is the most suitable treatment for your pain, he will personalize your treatment plan. You will be encouraged to raise any concerns you may have so that they can be addressed. You will be provided with preparation and aftercare instructions, and a date will be set for the procedure.
You will need to undergo tests like CT scans, urine tests, a pregnancy test, and blood tests. Additionally, you will undergo an MRI as a guide for Dr. Pouratian to determine the exact regions for lesion creation.
To prepare for the surgery, it is best to avoid smoking, since it can affect healing. It will also be necessary to arrange for a ride home from a friend or family member. Before going to the hospital for the procedure, you will need to remove all nail polish, makeup, and body piercings.
Before the cingulotomy is performed, an IV line will be placed, and a sedative will be administered to achieve a general anesthetic. Additionally, local anesthesia will be administered into the scalp for numbing purposes.
The cingulotomy procedure involves precisely placing probes into the anterior cingulate region. The precise placement of the probes usually requires use of a stereotactic frame. Dr Pouratian uses a Leksell frame. This frame will aid in precision while ensuring that the patient’s head does not move during the procedure.
With the aid of the MRI, an electrode will then be placed. Once the targeting is confirmed, a very precise lesion is made in the brain on each side.
The procedure can be immediately effective for the pain that it is targeting, with results in ~70% of patients. Cingulotomies are considered very safe, with a relatively low risk profile. There is <1% risk of bleeding associated with the procedure. While some patients may experience some temporary personality change, this usually resolves in a short period of time.
The patient will be observed for several days in the hospital after their cingulotomy surgery. They will then undergo a short recovery period at home. Post-surgical care instructions will be given by Dr. Pouratian during the initial consultation.
Prescriptions like antibiotics will be provided to aid the patient during recovery. Physical activities should be mild at first and can be gradually increased as directed by the doctor.
No lotions or ointments should be applied to the incision area. For two weeks, hair dryers should not be used. Hair dye should not be used for around twelve weeks.
It will be important to make sure that the incision is kept clean and dry to help prevent infection. Patients can wash their hair, providing they are very careful when patting the area dry.
A follow-up appointment will be scheduled to evaluate the recovery status of the patient and the results of the surgery. At this time, sutures will be removed.
Schedule Your Consultation
Patients considering a cingulotomy in Dallas can visit Dr. Nader Pouratian to find out more. Contact our office today to schedule your informative consultation.