Bilateral Cingulotomy

Psychosurgery for Mental Illnesses

Bilateral cingulotomy is a surgical procedure which may be performed in cases of treatment-resistant mental illnesses such as obsessive-compulsive disorder, bipolar disorder and major depression. According to the neurosurgical department of Massachusetts General Hospital/Harvard Medical School, " Only patients with severe, chronic, disabling and treatment refractory psychiatric illness should be considered for surgical intervention." Only when psychotherapeutic techniques, medication and possibly electroconvulsive therapy have been unsuccessful in relieving the patient's condition should psychosurgery be evaluated as an option.

This surgery targets the cingulate gyrus, a small area in the brain connecting the limbic system, which is involved with many emotions, and the frontal lobes, whose functions include reasoning, impulse control and judgment. About Biology Guide Regina Bailey lists the functions of the cingulate gyrus as:

• Coordinates Sensory Input With Emotions
• Emotional Responses to Pain
• Regulates Aggressive Behavior

To perform a bilateral cingulotomy, an electrode or gamma knife (which focuses beams of radiation) is guided to the target area by means of a process known as stereotactic magnetic resonance imaging. A small lesion is created there - about a 1/2 inch cut or burn.

At least one major insurance company, Blue Cross/Blue Shield of North Carolina, will only cover the procedure in cases of obsessive-compulsive disorder, stating that bilateral cingulotomy is considered an "investigational service" for bipolar disorder. This is in spite of studies showing that as many as 62% of patients with severe affective disorders achieved "worthwhile improvement" from the surgery. Side effects of this psychosurgery include "deficits of focused and sustained attention as well as mild executive dysfunction."

References

• Psychosurgery by Paula Anne Ford-Martin
• Psychosurgery - Massachusetts General Hospital
• Alteration of Intention and Self-Initiated Action Associated With Bilateral Anterior Cingulotomy
• Policy: Cingulotomy, Stereotactic Approach - Blue Cross/Blue Shield of North Carolina

Posted 1/12/06