疼痛管理是癌症治疗和姑息治疗的关键方面,疼痛会显著影响生活质量。慢性疼痛,这影响了全世界相当多的人,对患者来说仍然是一个普遍和具有挑战性的症状。虽然药物和社会心理支持系统在疼痛管理中发挥作用,外科和放射学干预措施,包括扣带切开术,对于难治性病例可能是必要的。扣带切开术,针对扣带回的神经外科手术,旨在破坏与情绪处理和痛觉相关的神经通路,从而减少疼痛的情感成分。尽管扣带切开术在缓解疼痛方面显示出了希望,特别是在传统药物治疗难以治疗的患者中,近年来,由于非破坏性治疗的进步以及对长期疗效和患者适用性的担忧,其使用有所下降。现代立体定向方法提高了扣带切开术的准确性和安全性,减少相关并发症和死亡率。尽管取得了这些进步,对于预期寿命有限的患者,其长期疗效和适用性仍存在疑问,尤其是那些癌症患者。根据系统审查和荟萃分析(PRISMA)2020指南的首选报告项目进行了全面的系统审查,旨在提供对功效的见解,潜在的好处,以及这种神经外科手术在治疗顽固性疼痛方面的局限性。PubMed的电子搜索,Embase,Scopus,和WebofScience是在开放数据库覆盖日期进行的。该综述的重点是疼痛强度和生活质量等结果。纳入标准包括任何年龄经历顽固性癌症或非癌症疼痛的人体研究。以扣带切开术为主要干预措施。考虑了各种研究设计,包括观察性研究,临床试验,以及以疼痛和扣带切开术为重点的评论。排除标准包括非人类研究,非同行评审的文章,以及与疼痛或扣带切开术无关的研究。这篇综述强调了立体定向前扣带切开术在治疗顽固性疼痛中的疗效。特别是当常规治疗失败时。先进的MRI引导技术提高了精度,但成本和专业知识等挑战依然存在。本综述中包含的研究显示,疼痛明显缓解,不良反应最小。尽管最佳目标仍存在争议。存在神经认知风险,但结果总体上是有利的。预期的不良事件包括短暂的影响,如尿失禁和意识模糊。如果疼痛控制不充分,可能需要再次手术,平均疼痛缓解时间为3个月至1年。双立体定向扣带切开术对于难治性疼痛似乎是安全有效的。
Pain management is a critical aspect of cancer treatment and palliative care, where pain can significantly impact quality of life. Chronic pain, which affects a significant number of people worldwide, remains a prevalent and challenging symptom for patients. While medications and psychosocial support systems play a role in pain management, surgical and radiological interventions, including cingulotomy, may be necessary for refractory cases.
Cingulotomy, a neurosurgical procedure targeting the cingulate gyrus, aims to disrupt neural pathways associated with emotional processing and pain sensation, thereby reducing the affective component of pain. Although
cingulotomy has shown promise in providing pain relief, particularly in patients refractory to traditional medical treatment, its use has declined in recent years due to advancements in non-destructive therapies and concerns about long-term efficacy and patient suitability. Modern stereotactic methods have enhanced the precision and safety of
cingulotomy, reducing associated complications and mortality rates. Despite these advancements, questions remain regarding its long-term efficacy and suitability for patients with limited life expectancy, particularly those with cancer. A comprehensive systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, aimed at providing insights into the efficacy, potential benefits, and limitations of this neurosurgical procedure in managing intractable pain. An electronic search of PubMed, Embase, Scopus, and Web of Science was conducted with open database coverage dates. The review focused on outcomes such as pain intensity and quality of life. The inclusion criteria encompassed human studies of any age experiencing intractable cancer or non-cancer pain, with cingulotomy as the primary intervention. Various study designs were considered, including observational studies, clinical trials, and reviews focusing on pain and cingulotomy. Exclusion criteria included non-human studies, non-peer-reviewed articles, and studies unrelated to pain or cingulotomy. This review highlights the efficacy of stereotactic anterior
cingulotomy in managing intractable pain, particularly when conventional treatments fail. Advanced MRI-guided techniques enhance precision, but challenges like cost and expertise persist. Studies included in this review showed significant pain relief with minimal adverse effects, although the optimal target remains debated. Neurocognitive risks exist, but outcomes are generally favorable. Expected adverse events include transient effects like urinary incontinence and confusion. Reoperation may be necessary for inadequate pain control, with a median pain relief duration of three months to a year. A double stereotactic
cingulotomy appears to be safe and effective for refractory pain.