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Sunil Manjila, Benoit Rosa, Margherita Mencattelli, Pierre E Dupont
BACKGROUND: Bilateral anterior cingulotomy has been used to treat chronic pain, obsessive compulsive disorder, and addictions. Lesioning of the target area is typically performed using bilateral stereotactic electrode placement and target ablation, which involves transparenchymal access through both hemispheres. OBJECTIVE: To evaluate an endoscopic direct-vision lesioning using a unilateral parasagittal minicraniotomy for minimally invasive bilateral anterior cingulotomy using a novel multiport endoscope through the anterior interhemispheric fissure...
May 4, 2018: Operative Neurosurgery (Hagerstown, Md.)
Assaf Berger, Rotem Tellem, Michal Arad, Uri Hochberg, Tal Gonen, Ido Strauss
Pain is one of the most common symptoms among cancer patients, and particularly in those who suffer from metastatic or terminal disease. There is great importance in delivering good pain management to these patients in order to alleviate their suffering, improve their functional status and their overall quality of life. In most cases, pain management is based on pharmacotherapy with opioids and other medications. However, there are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is associated with marked side effects...
February 2018: Harefuah
Ido Strauss, Assaf Berger, Shlomit Ben Moshe, Michal Arad, Uri Hochberg, Tal Gonen, Rotem Tellem
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...
2017: Stereotactic and Functional Neurosurgery
Sarah Farrand, Andrew H Evans, Simone Mangelsdorf, Samantha M Loi, Ramon Mocellin, Adam Borham, JoAnne Bevilacqua, Scott Blair-West, Mark A Walterfang, Richard G Bittar, Dennis Velakoulis
OBJECTIVE: Deep brain stimulation can be of benefit in carefully selected patients with severe intractable obsessive-compulsive disorder. The aim of this paper is to describe the outcomes of the first seven deep brain stimulation procedures for obsessive-compulsive disorder undertaken at the Neuropsychiatry Unit, Royal Melbourne Hospital. The primary objective was to assess the response to deep brain stimulation treatment utilising the Yale-Brown Obsessive Compulsive Scale as a measure of symptom severity...
September 1, 2017: Australian and New Zealand Journal of Psychiatry
Francis J Jareczek, Marshall T Holland, Matthew A Howard, Timothy Walch, Taylor J Abel
Neurosurgery for the treatment of psychological disorders has a checkered history in the United States. Prior to the advent of antipsychotic medications, individuals with severe mental illness were institutionalized and subjected to extreme therapies in an attempt to palliate their symptoms. Psychiatrist Walter Freeman first introduced psychosurgery, in the form of frontal lobotomy, as an intervention that could offer some hope to those patients in whom all other treatments had failed. Since that time, however, the use of psychosurgery in the United States has waxed and waned significantly, though literature describing its use is relatively sparse...
September 2017: Neurosurgical Focus
Matthew Volpini, Peter Giacobbe, G Rees Cosgrove, Anthony Levitt, Andres M Lozano, Nir Lipsman
BACKGROUND: There is an urgent need to develop safe and effective treatments for patients with treatment-resistant depression (TRD). Several neurosurgical procedures have been developed to treat the dysfunctional brain circuits implicated in major depression. OBJECTIVES: This review describes the most common ablative procedures used to treat major depressive disorder: anterior cingulotomy, subcaudate tractotomy, limbic leucotomy, and anterior capsulotomy. The efficacy and safety of each are discussed and compared with other current and emerging modalities, including deep brain stimulation (DBS) and MR-guided focused ultrasound (MRgFUS)...
2017: Stereotactic and Functional Neurosurgery
Guan-Chyuan Wang, Tomor Harnod, Tsung-Lang Chiu, Kuan-Pin Chen
BACKGROUND: Anterior cingulotomy (AC) was originally used to treat patients with a psychiatric disorder, but it is also useful for treating patients with chronic intractable pain. We reviewed 24 patients at our hospital who underwent AC for chronic intractable pain to determine whether surgery influenced patient cognition and the pain circuit. METHODS: A visual analog scale (VAS) was used to evaluate patients' pain scale preoperatively, at 1 month and 3-6 months postoperatively, and at the final follow-up...
June 2017: World Neurosurgery
Justin Sharim, Nader Pouratian
BACKGROUND: Anterior cingulotomy for chronic pain aims to modulate patients' attention or emotional reaction to pain rather than to modulate pain intensity. OBJECTIVES: To evaluate the clinical efficacy, both short- and long-term, of anterior cingulotomy in the treatment of chronic pain. STUDY DESIGN: Systematic review. SETTING: This systematic review assessed studies reporting anterior cingulotomy for the treatment of chronic pain...
November 2016: Pain Physician
Dirk De Ridder, Sook Ling Leong, Patrick Manning, Sven Vanneste, Paul Glue
BACKGROUND: Obsessive-compulsive disorder (OCD) is a brain disorder with a lifetime prevalence of 2.3%, causing severe functional impairment as a result of anxiety and distress, persistent and repetitive, unwanted, intrusive thoughts (obsessions), and repetitive ritualized behavior (compulsions). Approximately 40%-60% of patients with OCD fail to satisfactorily respond to standard treatments. Intractable OCD has been treated by anterior capsulotomy and cingulotomy, but more recently, neurostimulation approaches have become more popular because of their reversibility...
January 2017: World Neurosurgery
Serenella Tolomeo, David Christmas, Ines Jentzsch, Blair Johnston, Reiner Sprengelmeyer, Keith Matthews, J Douglas Steele
Converging evidence has linked the anterior mid-cingulate cortex to negative affect, pain and cognitive control. It has previously been proposed that this region uses information about punishment to control aversively motivated actions. Studies on the effects of lesions allow causal inferences about brain function; however, naturally occurring lesions in the anterior mid-cingulate cortex are rare. In two studies we therefore recruited 94 volunteers, comprising 15 patients with treatment-resistant depression who had received bilateral anterior cingulotomy, which consists of lesions made within the anterior mid-cingulate cortex, 20 patients with treatment-resistant depression who had not received surgery and 59 healthy control subjects...
June 2016: Brain: a Journal of Neurology
Purvee Patel, Nitesh V Patel, Shabbar F Danish
OBJECTIVE MR-guided laser-induced thermal therapy (MRgLITT) can be used to treat intracranial tumors, epilepsy, and chronic pain syndromes. Here, the authors report their single-center experience with 102 patients, the largest series to date in which the Visualase thermal therapy system was used. METHODS A retrospective analysis of all patients who underwent MRgLITT between 2010 and 2014 was performed. Pathologies included glioma, recurrent metastasis, radiation necrosis, chronic pain, and epilepsy. Laser catheters were placed stereotactically, and ablation was performed in the MRI suite...
January 1, 2016: Journal of Neurosurgery
Lauren T Brown, Charles B Mikell, Brett E Youngerman, Yuan Zhang, Guy M McKhann, Sameer A Sheth
OBJECT The object of this study was to perform a systematic review, according to Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) and Agency for Healthcare Research and Quality (AHRQ) guidelines, of the clinical efficacy and adverse effect profile of dorsal anterior cingulotomy compared with anterior capsulotomy for the treatment of severe, refractory obsessive-compulsive disorder (OCD). METHODS The authors included studies comparing objective clinical measures before and after cingulotomy or capsulotomy (surgical and radiosurgical) in patients with OCD...
January 2016: Journal of Neurosurgery
Sameer A Sheth, Robert McGovern, Charles B Mikell
INTRODUCTION: Neurosurgical treatments for refractory psychiatric disorders such as obsessive-compulsive disorder (OCD) are rapidly increasing. The National Institute of Mental Health has reclassified mental health disorders according to neurobiological mechanisms rather than traditional diagnostic categories. According to this Research Domain Criteria matrix, OCD would be classified as a disorder of cognitive control, with additional contributions from other axes. We bring together the neuroscientific literature on cognitive control and dorsal anterior cingulate cortex (dACC) function with human functional MRI (fMRI) and EEG data to demonstrate (1) the central role of the dACC in cognitive control; and (2) the relevance of this framework for the neurosurgical treatment of OCD...
August 2015: Neurosurgery
Timothy Y Mariano, Mascha van't Wout, Benjamin L Jacobson, Sarah L Garnaat, Jason L Kirschner, Steven A Rasmussen, Benjamin D Greenberg
OBJECTIVE: Pain remains a critical medical challenge. Current treatments target nociception without addressing affective symptoms. Medically intractable pain is sometimes treated with cingulotomy or deep brain stimulation to increase tolerance of pain-related distress. Transcranial direct current stimulation (tDCS) may noninvasively modulate cortical areas related to sensation and pain representations. The present study aimed to test the hypothesis that cathodal ("inhibitory") stimulation targeting left dorsal anterior cingulate cortex (dACC) would increase tolerance to distress from acute painful stimuli vs anodal stimulation...
August 2015: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
S H Sundararajan, P Belani, S Danish, I Keller
BACKGROUND AND PURPOSE: Cingulotomy is a well-accepted stereotactic procedure in the treatment of debilitating pain syndromes. At our institution, we used a 980-nm diode laser to perform MR imaging-guided laser-assisted cingulotomy. We report the early MR imaging changes associated with this technique. MATERIALS AND METHODS: In this retrospective analysis, MR imaging-guided laser-assisted cingulotomy was performed in 4 patients with intractable pain secondary to metastatic disease...
July 2015: AJNR. American Journal of Neuroradiology
H van Steenbergen, E Haasnoot, B R Bocanegra, E W Berretty, B Hommel
The role of mid-cingulate cortex (MCC), also referred to as dorsal anterior cingulate cortex, in regulating cognitive control is a topic of primary importance in cognitive neuroscience. Although many studies have shown that MCC responds to cognitive demands, lesion studies in humans are inconclusive concerning the causal role of the MCC in the adaptation to these demands. By elegantly combining single-cell recordings with behavioural methods, Sheth et al. [Sheth, S. et al. Human dorsal anterior cingulate cortex neurons mediate ongoing behavioural adaptation...
2015: Scientific Reports
Nitesh V Patel, Nitin Agarwal, Antonios Mammis, Shabbar F Danish
BACKGROUND: Bilateral anterior cingulotomy is well described for certain pain and psychiatric disorders. Typically, stereotactic frame-based radiofrequency ablation is used. We report the feasibility of a frameless approach using magnetic resonance imaging-guided laser induced thermal therapy (MRgLITT). OBJECTIVE: To report experience and outcomes for MRgLITT in bilateral anterior cingulotomy. METHODS: Three patients with chronic refractory cancer-related pain underwent bilateral anterior cingulotomy...
March 2015: Neurosurgery
Garrett P Banks, Charles B Mikell, Brett E Youngerman, Bryan Henriques, Kathleen M Kelly, Andrew K Chan, Diana Herrera, Darin D Dougherty, Emad N Eskandar, Sameer A Sheth
IMPORTANCE: Approximately 10% of patients with obsessive-compulsive disorder (OCD) have symptoms that are refractory to pharmacologic and cognitive-behavioral therapies. Neurosurgical interventions can be effective therapeutic options in these patients, but not all individuals respond. The mechanisms underlying this response variability are poorly understood. OBJECTIVE: To identify neuroanatomical characteristics on preoperative imaging that differentiate responders from nonresponders to dorsal anterior cingulotomy, a neurosurgical lesion procedure used to treat refractory OCD...
February 2015: JAMA Psychiatry
Jayant P Menon
Three main techniques delineate a possible role for intracranial ablative procedures in patients with chronic pain. Recent studies demonstrate a continued need for clinical investigation into central mechanisms of neuroablation to best define its role in the care of patients with otherwise intractable and severe pain syndromes. Cingulotomy can result in long-term pain relief. Although it can be associated with subtle impairments of attention, there is little risk to other cognitive domains.
October 2014: Neurosurgery Clinics of North America
Sarah R Heilbronner, Suzanne N Haber
The cingulum bundle (CB) is one of the brain's major white matter pathways, linking regions associated with executive function, decision-making, and emotion. Neuroimaging has revealed that abnormalities in particular locations within the CB are associated with specific psychiatric disorders, including depression and bipolar disorder. However, the fibers using each portion of the CB remain unknown. In this study, we used anatomical tract-tracing in nonhuman primates (Macaca nemestrina, Macaca fascicularis, Macaca mulatta) to examine the organization of specific cingulate, noncingulate frontal, and subcortical pathways through the CB...
July 23, 2014: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
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