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 goal of this surgery is to reduce the suffering and emotional component of pain. Although it is one of the more invasive procedures done for pain, it can provide the significant relief.
How Does it Work?
Pain signals that 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. 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.
Am I A Good Candidate?
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 relative indiscriminate in the types of pain it can help, but may be particularly helpful when there is a strong emotional burden related to the pain.
The cingulotomy procedure involves precisely placing probes in a very specific part of the brain, called the anterior cingulate region. The precise placement of the probes usually requires use of a stereotactic frame. Dr Pouratian uses a Leksell frame. 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.