钟乳体:对抗慢性顽固性疼痛的中心热点?

IF 4.1 Q1 CLINICAL NEUROLOGY
Brain communications Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI:10.1093/braincomms/fcae368
Linda Kollenburg, Hisse Arnts, Alexander Green, Ido Strauss, Kris Vissers, Saman Vinke, Erkan Kurt
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引用次数: 0

摘要

慢性疼痛给患者的生活造成了沉重负担,部分原因在于其对社会经济的深远影响。尽管开发出了各种药物治疗方法和(轻微)侵入性治疗,但仍有一部分患者难以治愈,因此在万不得已的情况下,应考虑采用其他有针对性的神经外科干预措施,如扣带切除术和前扣带皮层深部脑刺激术。尽管有临床证据支持这些疗法在治疗慢性顽固性疼痛方面的潜力,但医生们仍然不愿意在临床上使用这些疗法。部分原因在于缺乏对现有数据进行总结的清晰概述。因此,本文旨在评估扣带回切开术和前扣带回皮层深部脑刺激术在治疗慢性顽固性疼痛方面的现状,以深入了解在当今时代是否应重新考虑这些神经外科方法及其目标。本研究使用 PubMed 数据库进行文献检索。此外,还通过综述或文章中引用的参考文献对其他文章进行了人工检索。经排除后,仍分别有 24 篇和 5 篇文章被纳入对扣带回切除术和前扣带回皮层深部脑刺激术的分析。研究结果表明,目前已有多种关于扣带回切开术和前扣带回皮层深部脑刺激术的手术技术。结果显示,在随访≤6个月的肿瘤性和非肿瘤性疼痛患者中,分别有51%-53%和43%-64%的患者接受了扣带回切开术;在随访≥12个月的患者中,分别有82%(9/11)和76%(90/118)的患者接受了扣带回切开术。关于前扣带回皮层的深部脑刺激,没有关于肿瘤性疼痛的数据报告,但在≤6个月和≥12个月的随访中,分别有59%(10/17)和57%(8/14)的非肿瘤性疼痛患者被认为是应答者。报告最多的不良事件包括:进行扣带回切开术的患者出现情感变化(>6.9%,>29/420)和意识模糊(>4.8%,>20/420);进行前扣带回皮层深部脑刺激术的患者出现感染(12.8%,6/47)、癫痫发作(8.5%,4/47)和语义流畅性下降(6.4%,3/47)。由此可以得出结论,对于难治性非肿瘤性和肿瘤性疼痛患者,尤其是有情感情绪成分的患者,扣带回切除术和前扣带回皮层深部脑刺激是有效的最后手段。今后应将扣带回作为神经外科的靶点进行研究,因为它可以进一步探索治疗慢性顽固性疼痛的可行方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The cingulum: a central hotspot for the battle against chronic intractable pain?

Chronic pain causes a major burden on patient's lives, in part due to its profound socioeconomic impact. Despite the development of various pharmacological approaches and (minor) invasive treatments, a subset of patients remain refractory, hence why alternative targeted neurosurgical interventions like cingulotomy and deep brain stimulation of the anterior cingulate cortex should be considered in the last resort. Despite clinical evidence supporting the potential of these treatments in the management of chronic intractable pain, physicians remain reluctant on its clinical implementation. This can be partially attributed to the lack of clear overviews summarizing existent data. Hence, this article aims to evaluate the current status of cingulotomy and deep brain stimulation of the anterior cingulate cortex in the treatment of chronic intractable pain, to provide insight in whether these neurosurgical approaches and its target should be reconsidered in the current era. In the current study, a literature searches was performed using the PubMed database. Additional articles were searched manually through reviews or references cited within the articles. After exclusion, 24 and 5 articles remained included in the analysis of cingulotomy and deep brain stimulation of the anterior cingulate cortex, respectively. Results indicate that various surgical techniques have been described for cingulotomy and deep brain stimulation of the anterior cingulate cortex. Cingulotomy is shown to be effective 51-53% and 43-64% of patients with neoplastic and non-neoplastic pain at ≤6 months follow-up, and 82% (9/11) and 76% (90/118) at ≥ 12months follow-up, respectively. With regard to deep brain stimulation of the anterior cingulate cortex, no data on neoplastic pain was reported, however, 59% (10/17) and 57% (8/14) of patients with non-neoplastic pain were considered responders at ≤ 6 months and ≥ 12months follow-up, respectively. The most reported adverse events include change in affect (>6.9%, >29/420) and confusion (>4.8%, >20/420) for cingulotomy, and infection (12.8%, 6/47), seizures (8.5%, 4/47) and decline in semantic fluency (6.4%, 3/47) for deep brain stimulation of the anterior cingulate cortex. It can be concluded that cingulotomy and deep brain stimulation of the anterior cingulate cortex are effective last resort strategies for patients with refractory non-neoplastic and neoplastic pain, especially in case of an affective emotional component. Future research should be performed on the cingulum as a neurosurgical target as it allows for further exploration of promising treatment options for chronic intractable pain.

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