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Dorsal anterior cingulate cortex (ACC) deep brain stimulation (DBS): a promising surgical option for the treatment of refractory thalamic pain syndrome (TPS)

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

Neuroimaging evidences and previous successful case series of cingulotomy for cancer pain have disclosed the key-role of the dorsal anterior cingulate cortex (ACC) in the generation of the empathic and affective dimension of pain. The aim of this study is to assess the effectiveness and safety of ACC neuromodulation for the treatment of the thalamic pain syndrome (TPS), a chronic neuropathic disease often complicated by severe affective and emotional distress in the long term.

Method

From January 2015 to April 2017, 5 patients with pure drug-refractory TPS underwent ACC deep brain stimulation (DBS) at our institution. Quantitative assessment of pain and health-related quality of life were performed 1 day before surgery and postoperatively at 6 and 18 months by using the numeric rating scale (NRS), the 36-item short-form health survey (SF-36), and the McGill pain and the EuroQol5-domain questionnaires.

Results

Mean age at surgery was 56.2 years (range, 47–66). NRS score improved by 37.9% at 6 months (range, − 22.2 to − 80%) and by 35% at 18 months (range, − 11.1 to − 80%). At the last follow-up, one patient reported a relevant pain reduction (NRS 2), only complaining of mild pain poorly interfering with activities of daily living. Concomitant improvements in the McGill and EuroQol5-domain pain questionnaires, SF-36 total and sub-item scores were also noticed at each follow-up. No surgical or stimulation-related complications occurred during the study period.

Conclusions

ACC DBS may be a safe and promising surgical option to alleviate discomfort and improve the overall quality of life in a patient affected by drug-resistant TPS. Further prospective, larger, and randomized studies are needed to validate these findings.

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Authors and Affiliations

  1. Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy

    Vincenzo Levi, Roberto Cordella, Antonio D’Ammando, Giovanni Tringali, Ivano Dones, Giuseppe Messina & Angelo Franzini

Authors
  1. Vincenzo Levi
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  2. Roberto Cordella
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  3. Antonio D’Ammando
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  4. Giovanni Tringali
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  5. Ivano Dones
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  6. Giuseppe Messina
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  7. Angelo Franzini
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Corresponding author

Correspondence to Vincenzo Levi.

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Conflict of interest

Vincenzo Levi is a medical advisor at NEWRONIKA SRL (deep brain stimulation internal pulse generator manufacturer). All the authors declare that they have no financial or other conflicts of interest in relation to this research and its publication. The authors also declare that they received no specific funding for this work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Functional Neurosurgery - Pain

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Levi, V., Cordella, R., D’Ammando, A. et al. Dorsal anterior cingulate cortex (ACC) deep brain stimulation (DBS): a promising surgical option for the treatment of refractory thalamic pain syndrome (TPS). Acta Neurochir 161, 1579–1588 (2019). https://doi.org/10.1007/s00701-019-03975-5

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  • DOI: https://doi.org/10.1007/s00701-019-03975-5

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