Kollenburg Linda, Arnts Hisse, Green Alexander, Strauss Ido, Vinke Saman, Kurt Erkan
Department of Neurosurgery, Functional Neurosurgery Unit, Radboud University Medical Center, Nijmegen 6525 GA,Netherlands.
Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neuroscience and Surgery, University of Oxford, Oxford OX39DU, UK.
Brain Commun. 2025 Jan 31;7(1):fcaf048. doi: 10.1093/braincomms/fcaf048. eCollection 2025.
For over half a century, the cingulum has been the subject of neuroanatomical and therapeutic investigations owing to its wide range of functions and involvement in various neurological and psychiatric diseases. Recent clinical studies investigating neurosurgical techniques targeting the cingulum, like deep brain stimulation of the anterior cingulate cortex and cingulotomy, have further boosted interests in this central 'hub' as a target for chronic intractable pain. Proper targeting within the cingulum is essential to achieve sufficient pain relief. Despite the cingulum being the centre of research for over a century, its structural and functional organization remains a subject to debate, consequently complicating neurosurgical targeting of this area. This study aims to review anatomical and connectivity data of the cingulum from a clinical perspective in order to improve understanding of its role in pain. For the current study, a systematic literature search was performed to assess the anatomy and functional and structural connectivity of the cingulate bundle and cortex. These outcomes focus on MRI and PET data. Articles were searched within the PubMed database, and additional articles were found manually through reviews or references cited within the articles. After exclusion, 70 articles remained included in this analysis, with 50, 29 and 10 studies describing human, monkey and rat subjects, respectively. Outcomes of this analysis show the presence of various anatomical models, each describing other subdivisions within the cingulum. Moreover, connectivity data suggest that the cingulate bundle consists of three distinct fibre projections, including the thalamocortical, cingulate gyrus and anterior frontal and posterior parietal projections. Further, the cingulum is responsible for a variety of functions involved in chronic pain, like sensory processing, memory, spatial functioning, reward, cognition, emotion, visceromotor and endocrine control. Based on the current outcomes, it can be concluded that the cingulum is a central 'hub' for pain processing, because it is a melting pot for memory, cognition and affect that are involved in the complex phenomenon of pain experience, memory, spatial functioning, reward, cognition, emotion, visceromotor and endocrine control. Variability in anatomical and connectivity models complicate proper and standardized neurosurgical targeting, consequently leading to clinicians often being reluctant on stimulation and/or lesioning of the cingulum. Hence, future research should be dedicated to the standardization of these models, to allow for optimal targeting and management of patients with chronic intractable pain.
半个多世纪以来，由于扣带束功能广泛且涉及多种神经和精神疾病，一直是神经解剖学和治疗学研究的对象。最近的临床研究调查了针对扣带束的神经外科技术，如前扣带回皮质的深部脑刺激和扣带束切开术，进一步激发了人们对这个中枢“枢纽”作为慢性顽固性疼痛靶点的兴趣。在扣带束内进行准确的靶点定位对于实现充分的疼痛缓解至关重要。尽管扣带束在一个多世纪以来一直是研究的核心，但它的结构和功能组织仍然存在争议，因此使该区域的神经外科靶点定位变得复杂。本研究旨在从临床角度回顾扣带束的解剖学和连接性数据，以增进对其在疼痛中作用的理解。对于当前的研究，进行了系统的文献检索，以评估扣带束和皮质的解剖结构以及功能和结构连接性。这些结果聚焦于MRI和PET数据。在PubMed数据库中搜索文章，并通过文章中的综述或参考文献手动查找其他文章。排除后，本分析纳入了70篇文章，其中分别有50、29和10项研究描述了人类、猴子和大鼠受试者。该分析结果表明存在各种解剖模型，每个模型都描述了扣带束内的其他亚区。此外，连接性数据表明扣带束由三种不同的纤维投射组成，包括丘脑皮质、扣带回以及前额叶和顶叶后部投射。此外，扣带束负责多种与慢性疼痛相关的功能，如感觉处理、记忆、空间功能、奖赏、认知、情感、内脏运动和内分泌控制。基于当前的结果，可以得出结论，扣带束是疼痛处理的中枢“枢纽”，因为它是记忆、认知和情感的融合点，这些因素都参与了疼痛体验、记忆、空间功能、奖赏、认知、情感、内脏运动和内分泌控制的复杂现象。解剖学和连接性模型的变异性使准确和标准化的神经外科靶点定位变得复杂，因此导致临床医生常常不愿对扣带束进行刺激和/或损伤。因此，未来的研究应致力于这些模型的标准化，以便对慢性顽固性疼痛患者进行最佳的靶点定位和治疗。
