Bilateral cingulotomy is a psychosurgical procedure used to treat refractory depression, obsessive compulsive disorder that has not responded to drug treatment, and, rarely, chronic pain syndrome.
The bilateral cingulotomy is often an adjunct to and not a substitute for treatment. The goal of the surgery is to sever the supracallosal fibers of the cingulum bundle, which passes through the anterior cingulate gyrus.
The operation targets the anterior cingulate cortex, which is a part of the limbic system. This system controls and affects the integration of feelings and emotion in the human cortex. It includes the cingulate gyrus, parahippocampal gyrus, amygdala, and the hippocampal formation.
The bilateral cingulotomy was first performed in the 1950s as an alternative to standard prefrontal lobotomy in an attempt to treat the symptoms of mental illness while reducing the undesirable effects, such as personality changes. In the 1940s and early 1950s psychosurgery became popular in the United States and prefrontal lobotomies were performed for intractable mental illness, in particular, depression, anxiety, and obsessive-compulsive disorders. However, negative side effects led to the innovation and implementation of new and less invasive surgical approaches. Building on earlier hypotheses, American physiologist James Fulton first suggested that the anterior cingulum would be an appropriate psychosurgical target for a safe and effective cingulotomy.
After surgery, the patient may experience an immediate reduction in anxiety, but beneficial effects on depression and obsessive compulsive disorder take longer to appear, and recovery usually takes four days. If there is no benefit after several months, another surgery may be performed.
See also Brain ; Brain disorders ; Brain injuries ; Neuroimaging ; Neuron .
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