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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
G S Malhi, P K Bridges, A L Malizia
The use of neurosurgery for mental disorders (NMD) is a clinical issue that involves many ethical considerations. It is a treatment that offers hope for many patients with severe and debilitating affective and anxiety disorders and should be widely available. Its current use worldwide (UK, Sweden, US, Australasia, Europe) is reviewed and the types of procedures currently used are explained (stereotactic subcaudate tractotomy, anterior capsulotomy, cingulotomy, limbic leucotomy). In addition, clinical strategies for the evaluation and management of patients both prior to and following NMD are discussed...
1997: International Journal of Psychiatry in Clinical Practice
Charles R Conway, Mehret D Gebretsadik, Richard D Bucholz
Treatment-resistant major depression (TRMD, major depressive disorder that fails to respond to numerous therapies) is a relatively common and clinically challenging disorder. In many cases, the most severely affected TRMD patients have received surgical intervention (subcaudate tractotomy, limbic leucotomy, anterior capsulotomy, and anterior cingulotomy). New treatments, including vagus nerve stimulation (VNS) and deep brain stimulation, have emerged to treat individuals with TRMD. We describe the case of a woman, 53 years of age, with a long and sustained history of TRMD (33 years), which was unresponsive to numerous treatments (multiple pharmacotherapies, psychotherapy, electroconvulsive therapy [ECT])...
June 2011: CNS Spectrums
Andre F Gentil, Antonio C Lopes, Darin D Dougherty, Christian Rück, David Mataix-Cols, Teagan L Lukacs, Miguel M Canteras, Emad N Eskandar, K Johan Larsson, Marcelo Q Hoexter, Marcelo C Batistuzzo, Benjamin D Greenberg, Euripedes C Miguel
UNLABELLED: OBJECT.: Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome...
July 2014: Journal of Neurosurgery
Bart Nuttin, Hemmings Wu, Helen Mayberg, Marwan Hariz, Loes Gabriëls, Thorsten Galert, Reinhard Merkel, Cynthia Kubu, Osvaldo Vilela-Filho, Keith Matthews, Takaomi Taira, Andres M Lozano, Gastón Schechtmann, Paresh Doshi, Giovanni Broggi, Jean Régis, Ahmed Alkhani, Bomin Sun, Sam Eljamel, Michael Schulder, Michael Kaplitt, Emad Eskandar, Ali Rezai, Joachim K Krauss, Paulien Hilven, Rick Schuurman, Pedro Ruiz, Jin Woo Chang, Paul Cosyns, Nir Lipsman, Juergen Voges, Rees Cosgrove, Yongjie Li, Thomas Schlaepfer
BACKGROUND: For patients with psychiatric illnesses remaining refractory to 'standard' therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. METHODS: To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines...
September 2014: Journal of Neurology, Neurosurgery, and Psychiatry
Jimmy C Yang, Daniel T Ginat, Darin D Dougherty, Nikos Makris, Emad N Eskandar
OBJECT: Cingulotomy and limbic leucotomy are lesioning surgeries with demonstrated benefit for medically intractable psychiatric illnesses. They represent significant refinements of the prefrontal lobotomy used from the 1930s through the 1950s. However, the associations between anatomical characterization of these lesions and outcome data are not well understood. To elucidate these procedures and associations, the authors sought to define and compare the neuroanatomy of cingulotomy and limbic leucotomy and to test a method that uses neuroanatomical data and voxel-based lesion-symptom mapping (VLSM) to reveal potential refinements to modern psychiatric neurosurgical procedures...
January 2014: Journal of Neurosurgery
Erlick A C Pereira, Menaka Paranathala, Jonathan A Hyam, Alexander L Green, Tipu Z Aziz
BACKGROUND: Bilateral anterior cingulotomy is a palliative procedure occasionally used for cancer pain, and human studies suggest anterior cingulate cortex is active in dyspnoeic states. OBJECTIVES: A case of debilitating thoracic wall pain due to malignant mesothelioma relieved by bilateral anterior cingulotomy is described and changes in dyspnoea investigated. RESULTS: Improvements in pain, dyspnoea and the extent to which either symptom bothered the patient was seen for 2 months after surgery before disease progression led to death 5 months after surgery...
August 2014: British Journal of Neurosurgery
Marwan I Hariz, Gun-Marie Hariz
The renaissance of functional stereotactic neurosurgery was pioneered in the mid 1980s by Laitinen's introduction of Leksell's posteroventral pallidotomy for Parkinson´s disease (PD). This ablative procedure experienced a worldwide spread in the 1990s, owing to its excellent effect on dyskinesias and other symptoms of post-l-dopa PD. Modern deep brain stimulation (DBS), pioneered by Benabid and Pollak in 1987 for the treatment of tremor, first became popular when it was applied to the subthalamic nucleus (STN) in the mid 1990s, where it demonstrated a striking effect on all cardinal symptoms of advanced PD, and permitted reduced dosages of medication...
2013: Handbook of Clinical Neurology
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