Stereotactic bilateral anterior cingulotomy for intractable pain

To document the value of cingulotomy for pain relief, a series of 22 patients with medically intractable pain, including 15 with cancer pain and seven with non-cancer pain, underwent stereotactic bilateral anterior cingulotomy, between August 2001 and December 2002. Of the 15 patients with cancer pain, significant or meaningful pain relief was achieved in 67% of patients at one month follow-up, which decreased to 58% at three months and 50% at six months. Of the seven patients with intractable pain from non-neoplastic origin, four achieved significant pain relief, one obtained meaningful relief, and two reported no change at one year follow-up. There was no surgical mortality or permanent neurological morbidity. Two patients developed transient confusion and another two had mild gastrointestinal bleeding. No clinically evident personality or emotional changes were noted. However, subtle cognitive impairment, especially attentional deficits, were detected through detailed neuropsychological evaluation.