난치성 암성 통증 제어를 위한 뇌정위적 대상회 절개술

Treatment of Intractable Cancer Pain by Stereotactic Bilateral Anterior Cingulotomy

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.