Tuesday, July 5, 2011

Bilateral Cingulotomy

Bilateral cingulotomy is a brain surgical procedure which is used treat obsessive compulsive disorder, depression, and bipolar psychosis. In bilateral cingulotomy the supracallosal fibers of the cingulum bundle, which passes through the anterior cingulate gyrus, are severed. The anterior cingulate cortex is a part of the limbic system, which is responsible for the integration of feelings and emotion in the human cortex. It consists of the cingulate gyrus, parahippocampal gyrus and the hippocampal formation. Studies in patients that were subjects to bilateral cingulotomy showed that the anterior cingulate cortex has a key role in cognitive control and is highly likely to be involved in the control of attentional response, whereas the dorsal part of that region of the brain was not identified to be involved in such a process, although this is still under dispute.

In bilateral cingulotomy, burr holes are made into the patient’s skull using a drill. Lesions at the targeted tissue are made with the help of fine electrodes inserted very carefully at the right angle into the subject’s brain based on plotting charts and making sure important arteries and blood vessels are intact. The electrode is placed in a probe with only its tip projecting. Upon the correct insertion of the holder into the brain tissue, air is injected and more scan images are taken. Then, after the medical team has made sure they are on the right track, the tip of the electrode is advanced to the plane of the cingulate where it is heated to 75-90 C. Once the first lesion is created it serves as a center around which several other lesions are created. In order to confirm whether lesions are made at the right place, scan images are taken postoperatively and analyzed.