Best target position and range of lesion for magnetic resonance image -guided stereotactic cingulotomy

Abstract

Objective To explore the best target position and range of lesion for magnetic resonance image (MRI)-guided stereotactic cingulotomy. Methods We retrospectively analyzed the data of 71 patients underwent MRI-guided stereotactic cingulotomy, including 7 with chronic pain and 64 with psychiatric disorders. The cingulate gyrus target chose were 5 mm as X, 10-20 mm posterior tip of the lateral ventricle as Y, 2 mm above the roof of the lateral ventricle as Z. The target position and range of lesion were determined and revised by routine sagittal, axial and coronal stereotactic MRI scans. Radiofrequency thermocoagulation lesions were produced by inserting an electrode (1.6 mm diameter and 4 mm uninsulated tip) and heating them at a temperature of 75℃ for 100 seconds with a volume of lesion reaching 15 mm×10 mm×10 mm. Early postoperative MR or CT scans and long-term followed up examination were available for all cases. Results Postoperative images showed that the lesions were all in the anterior cingulate gyrus. Two patients reported transient urinary incontinence without permanent complications; significant pain relief appeared in all patients with chronic pain; In 64 with intractable psychiatric disorders, cure was showed in 3 obvious improvements in 35, improvement in 22, and no change in 4. Conclusion MRI-guided stereotactic cingulotomy offers substantial advantages by allowing direct visualization of the cingulate gyrus and surrounding structures and the best range of lesion is 10-25 mm from the anterior point of the corpus callosum, 10 mm above the bottle of cingulate gyrus and 10 mm in width. Key words: Cingulotomy; Stereotactic surgery; MRI