Cingulotomy is a neurosurgical procedure in which doctors use specialized tools to inactivate brain tissue in areas that are associated with a variety of debilitating diseases, including chronic pain and obsessive-compulsive disorder (OCD). It was first developed in the 1960s and has been studied extensively since that time. Over the past decades, advances in technology have made this procedure minimally invasive, improving safety and recovery time.
Chronic pain patients who benefit from this treatment report an improved quality of life and less preoccupation with their pain. Cingulotomy targets the "bothersome" aspect of pain. Although not all patients are completely free of pain after the procedure, many report feeling less anxiety and less distress from any pain that remains. Additionally, cingulotomy has the potential to decrease the amount of medication required to manage pain, thereby reducing side effects.
Patients with severe, treatment-resistant OCD who benefit from this procedure report that their symptoms are "turned down or easier to keep in the background." Previously ineffective medical or behavioral treatments may finally be effective.
When is Cingulotomy performed?
Appropriate candidates for cingulotomy are individuals for whom traditional medical and/or surgical therapies have been unsuccessful. Cingulotomy is a non-reversible procedure and is therefore reserved for those patients or whom all other options have been exhausted.
In chronic pain patients, the greatest benefit is usually experienced by those whose pain is related to stroke, cancer, or spinal cord injury. Generally, pain must have been present for a period of at least six months and multiple conventional therapies must have already been tried.
Individuals with OCD must have medically refractory, severe OCD. A multidisciplinary team of specialists from psychiatry, psychology, neurology, and neurosurgery reviews cases to determine whether surgery may be appropriate.
How should I prepare for Cingulotomy?
Modem cingulotomy is most often performed using thermal energy or specialized laser systems. No large open incision is required. and many patients are able to go home the following day.
During the procedure, focused energy is used to create small lesions in the anterior cingulate cortex, a part of the limbic system. Sometimes called “the feeling and reacting brain,” the limbic system helps the brain respond to emotion, regulate motivation and reinforcement, and form new memories.
At Columbia, cingulotomy is performed using a minimally invasive, FDA-approved laser system that allows surgeons to pinpoint the target brain region with extreme precision. The lesion is created using real-time MRI guidance so that the surgeon can accurately monitor the lesion and control its size and shape. This unique method also minimizes the chance of damaging nearby normal brain structures.