title: Anterior cingulotomy improves malignant mesothelioma pain and dyspnoea.
abstract: BACKGROUND
  Bilateral anterior cingulotomy is a palliative procedure occasionally used for cancer pain, and human studies suggest anterior cingulate cortex is active in dyspnoeic states.
  
  
  OBJECTIVE
  A case of debilitating thoracic wall pain due to malignant mesothelioma relieved by bilateral anterior cingulotomy is described and changes in dyspnoea investigated.
  
  
  RESULTS
  Improvements in pain, dyspnoea and the extent to which either symptom bothered the patient was seen for 2 months after surgery before disease progression led to death 5 months after surgery. Quality of life improvements were also seen for 2 months after surgery and pain relief was sustained from surgery to death. Arterial blood gas and lung function tests were unchanged by surgery, suggesting a reduction in pain and dyspnoea awareness by cingulotomy.
  
  
  CONCLUSIONS
  Bilateral anterior cingulotomy effectively relieved both pain and dyspnoea. The role of the anterior cingulate cortex in pain and autonomic control of respiration is discussed alongside the evidence for this palliative procedure for cancer pain.
authors.affiliation: Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Surgical Sciences, University of Oxford , Oxford , UK and Department of Neurological Surgery, The West Wing, John Radcliffe Hospital , Oxford , UK.
authors.forename: Erlick A C
authors.initials: EA
authors.lastname: Pereira
authors.forename: Menaka
authors.initials: M
authors.lastname: Paranathala
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Hyam
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Green
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000209:etiology*; D017809:Fatal Outcome; D006179:Gyrus Cinguli / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D011788:Quality of Life
keywords: cancer pain; cingulotomy; dyspnoea; lesion; mesothelioma