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. 2024 Jul 15;8(3):CASE2459.
doi: 10.3171/CASE2459. Print 2024 Jul 15.

Feasibility of targeting the cingulate gyrus using high-intensity focused ultrasound on a cadaveric specimen: illustrative case

Francesco Sammartino  1 , James Mossner  2 , Hunter Stecko  3 , Nihaal Reddy  3 , Brian Dalm  4
Affiliations

Feasibility of targeting the cingulate gyrus using high-intensity focused ultrasound on a cadaveric specimen: illustrative case

Francesco Sammartino et al. J Neurosurg Case Lessons. .

Abstract

Background: Cancer is commonly associated with pain. For patients with advanced cancer and intractable pain, ablative neurosurgical procedures can significantly improve pain and transition patients out of inpatient settings. These procedures are normally invasive, and this poses an important risk in this population. Cingulotomy has been reported to improve pain perception and contribute substantially to the quality of life of cancer patients with refractory pain.

Observations: One fresh human cadaver specimen was used for the setup. The cingulate gyrus was targeted using intraoperative magnetic resonance images, and osseous aberrations were corrected after coregistration with the preoperative head computed tomography. After accounting for sinuses, membrane folds, and calcifications, a total of 737 elements were available for thermal ultrasound ablation. On high-power sonications, the total energy delivered reached a peak temperature of 57°C (15,050 J, 350 W, 45 seconds) in the right cingulate and 52°C (13,000 J, 405 W, 46 seconds) in the left cingulate.

Lessons: Despite the limitations of using a cadaver model (temperature, vascularization), cingulotomy appears to be feasible using high-intensity focused ultrasound. https://thejns.org/doi/10.3171/CASE2459.

Keywords: cadaver study; cancer pain; cingulotomy; focused ultrasound ablation.

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Figures

FIG. 1.
FIG. 1.
Axial (A), sagittal (B), and coronal (C) Kranion images showing intracranial areas that are easily accessible (green), on the periphery of accessibility (yellow), and outside the accessibility (red) of the Exablate transducer envelope. Kranion output (D) showing the transducer in relationship to the skull, with the green dots indicating the active transducer elements used and the red dots indicating the inactive elements.
FIG. 2.
FIG. 2.
The cingulotomy target location of the right cingulate gyrus is demarcated by the green crosshairs (A). Map of the elements from the console (B).
FIG. 3.
FIG. 3.
The composite figure shows the ill-defined lesion that was present within the cadaveric specimen.
See this image and copyright information in PMC

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