Bilateral Cingulotomy

Author: Brander Sattler

From: East Meadow, NY, USA


Can surgery really treat OCD? What about chronic pain? Even depression? The answer to all of those questions is yes! The surgery is called bilateral cingulotomy, and it is only used as a last resort if all other forms of treatment fail.


History of Bilateral Cingulotomy


American physiologist John Farquhar Fulton first developed bilateral cingulotomy in the late 1940s. This type of surgery was used as an alternative to lobotomy: a type of surgery that severs the connection in the prefrontal cortex of the brain. Over the next few decades, this procedure has seen improvements and developments as it has become minimally invasive and patient recovery time has decreased.


Which Parts of the Brain are Targeted?


The cingulate gyrus (which helps regulate pain and emotions) and the frontal lobes (which helps reasoning, impulse control, and judgment) are targeted using an electrode or gamma knife (targeted radiation knife). The surgeon guides the knife to the appropriate parts of the brain using magnetic resonance imaging (MRI). A stereotactic frame is placed on the patient’s head to ensure precise targeting and to ensure that the patient's head does not move. Once the knife reaches the cingulate gyrus or the frontal lobes, the knife cuts the circuits of the brain.


The Rationale


The cingulate gyrus connects experiences and sensations to either pleasant or unpleasant memories, thus inducing an emotional response to many senses we experience. This part of the brain also connects to the caudate nucleus, which forms habits. By severing these connections, the connections that cause painful emotion (which helps with pain and depression), as well as habitual behavior (which helps with OCD), will also be severed.


Controversy Around the Procedure


This surgery is extremely controversial and most physicians and surgeons only suggest performing this procedure as a last resort to all other forms of treatment. In fact, consent from both the patient and their families is needed to perform this procedure.


Success of the Procedure


Even though this procedure reduces pain, it is by no means a cure. 60-70 percent of patients reported a decrease in pain, with 14 percent experiencing short-term side effects and five percent experiencing severe side effects. Although this procedure has been somewhat successful, you will most likely never have to experience it as it is only a last-resort treatment.


Before You Go:


While we are on the topics of OCD, depression, and chronic pain, if you are experiencing any symptoms of OCD, depression, or any form of chronic pain, it is important to seek help from a medical professional. SAMHSA's National Helpline number is 1-800-622-HELP if you are facing any mental or substance abuse disorders. Remember to stay safe and healthy!!

 

Author: Branden Sattler


Branden is a senior at East Meadow High School. He has a passion for psychology and wants to understand how different aspects of life affect a person’s emotional well-being.

 
  1. Purse, M. (2020, September 25). Surgery can be a last resort for obsessive compulsive disorder. Verywell Mind. Retrieved February 21, 2022, from https://www.verywellmind.com/bilateral-cingulotomy-380662#:~:text=Bilateral%20cingulotomy%20is%20a%20type,any%20other%20form%20of%20therapy.

  2. Samhsa's national helpline: Samhsa - Substance Abuse and Mental Health Services Administration. SAMHSA. (n.d.). Retrieved February 21, 2022, from https://www.samhsa.gov/find-help/national-helpline

  3. Steele, J. D., Christmas, D., Eljamel, M. S., & Matthews, K. (2008). Anterior cingulotomy for major depression: Clinical outcome and relationship to lesion characteristics. Biological Psychiatry, 63(7), 670–677. https://doi.org/10.1016/j.biopsych.2007.07.019





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