Cingulotomy for Cancer Pain

Abstract

Stereotactic anterior cingulotomy is a neurosurgical technique that can offer significant pain relief in patients with refractory cancer pain, particularly in the palliative setting. Despite being described in the 1960s, its use has recently resurged due to limitations of pharmacologic and neuromodulatory therapies in terminally ill patients. The anterior cingulate cortex plays a crucial role in the affective processing of pain, and its disruption through targeted lesioning may reduce suffering without eliminating nociception. This review summarises the historical background, patient selection criteria, surgical approaches, efficacy data, and safety outcomes associated with bilateral anterior cingulotomy for cancer-related pain. Additionally, the Queen Square approach, incorporating MRI-guided targeting and diffusion imaging, is described. Available data support the procedure's short-term efficacy in the majority of patients, with limited cognitive side effects and minimal morbidity. Future directions include network-based targeting, refinement of lesion techniques, and consideration of non-invasive alternatives such as focused ultrasound. Further research is warranted to optimise selection criteria and understand the neural mechanisms underlying pain relief.