Bilateral cingulotomy

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Bilateral cingulotomy is a form of psychosurgery, introduced in 1952 as an alternative to lobotomy. Today, it is mainly used as a last resort for the treatment of obsessive-compulsive disorder and chronic pain. The objective of this surgical procedure is the severing of the supracallosal fibres of the cingulum bundle, which pass through the anterior cingulate gyrus.[1]



Bilateral Cingulotomy targets the anterior cingulate cortex, which is a part of the limbic system. This system 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.[2]

Studies in patients that were a subject to bilateral cingulotomy, that involved fMRI analyses, 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.[3] The function of the dorsal part of the cingulate cortex was connected to the sorting out and processing of conflicting information signals. In addition, neuroimaging studies also indicated that the anterior cingulate cortex participates in the modulation of cortical regions that are of higher order as well as sensory processing areas.[4]

These findings have also been confirmed by stereotactic microelectrode analysis of single cortical neurons in a study, which involved nine patients undergoing bilateral cingulotomy.[3] The study investigated the effect of performing attention demanding tasks on the activity of 36 neurons located in the anterior cingulate cortex. Upon analyzing of the results of the study it was concluded that the anterior cingulate cortex is indeed involved in the modification of cognitive tasks that require attention based on the fact that there was a change in the basal firing rate of neurons in that region during simulation of such tasks.[3]

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