Cingulotomy: Treatment, Effects & Risks

Cingulotomy is the name given to a surgical treatment of the brain. The treatment was developed as an alternative to lobotomy or leucotomy in the 1940s and is now used only in very severe cases of mental illness.

What is cingulotomy?

Cingulotomy is a form of psychosurgery. It is a surgical procedure applied to cut the anterior cingulate cortex. Cingulotomy was developed in the 1940s as an alternative to lobotomy. It was hoped that cingulotomy would be a psychosurgical procedure with calculable side effects and sequelae. Since lobotomy, which had been used until then, resulted in severe physical and mental impairments in patients, which in some cases made them nursing cases for life, an alternative psychosurgical intervention was sought. This was introduced in the form of cingulotomy by American physiologist John Farquhar Fulton. Fulton introduced the cingulotomy to the Society of British Neurosurgeons in 1947 with the statement “if it were feasible, the cingulotomy would have a proper place in the form of a limited leucotomy.” Fulton further referred to neuroanatomist James Papez, who believed the cingulate gyrus plays an important role in human emotions.

Function, effect, and goals

Cingulotomy replaced lobotomy in the mid-20th century and was used particularly to treat patients with psychosis, depression, obsessive-compulsive disorder, and schizophrenia. Patients with other neurological disorders such as Parkinson’s disease, Tourette’s syndrome, anorexia, and epilepsy were also eligible for the surgical procedure. Cingulotomy targets the anterior cingulate cortex. This takes on an essential role in the regulation of autonomic functions of the body such as heartbeat or blood pressure. Furthermore, the brain area also plays an important role in rational and emotional processes. Processes such as decision making as well as impulse control are significantly influenced by the anterior cingulate cortex. Interfaces between the emotional and rational levels, such as the reward and expectancy systems, are also substantially conditioned here. According to recent neurological studies, the various functions can be established in further sublevels of the anterior cingulate cortex. Until the 90s of the 20th century, the surgical procedure took place as follows: First, a series of computed tomographic scans are taken of the patient’s brain to ensure accurate localization of the anterior cingulate cortex. Now, a number of holes are drilled into the patient’s skull and then special electrodes are inserted into the patient’s brain. The integrity of the arteries and blood vessels, which are essential for survival, is of utmost importance during the operation. Therefore, a series of additional imaging scans are taken over the inserted electrodes before the actual cingulotomy begins. The electrodes are then moved toward the anterior cingulate cortex according to a precise route dictated by the cts made and other imaging procedures. After reaching the anterior cingulate cortex with the electrode through this procedure, the electrode is heated to approximately 75-90 °C. The resulting injury is then used as a target for the imaging of the anterior cingulate cortex. The resulting lesion now serves as a central point around which further lesions are inserted into the area. The use of magnetic resonance imaging has improved the precision of cingulotomy. Because MRI not only provides much more accurate information about the location of the brain area, but also allows differentiation of cell composition, the gray matter to be operated on is better identified. Unnecessary lesions are largely avoided as a result. A further advance for cingulotomy is the gamma knife or gamma knife. This method uses targeted radiological radiation to cut through the brain tissue and eliminates many of the complications of conventional cingulotomy. By cutting the anterior cingulate cortex, many mental disorders, especially obsessive-compulsive disorder and depression, could be eliminated. However, the results turn out to be very radical, as there are numerous uncontrollable side effects and sequelae in addition to the controlled removal of the mental disorder.Severe personality changes and permanent immobilization are only the most common subsequent complaints of patients. Due to the development of effective psychotropic drugs, the number of psychosurgical interventions has decreased significantly. Furthermore, since the 1950s, society has become increasingly aware of the dangers and side effects, which further promotes a decrease in interventions.

Risks, side effects, and dangers

Because cingulotomy causes an irreversible change in human character and numerous side effects and sequelae can occur, the procedure is used in the 21st century on an extremely limited basis. Mild side effects have been described as nausea, incontinence, vomiting, and headache in the first days after surgery. However, in addition to mild side effects, irreversible sequelae occur that cannot be assessed in advance. Patients often appear retarded and childlike or otherwise conspicuous. Hydrocephalus occurred in two percent of the patients observed. A persistent disinterest in the world and life itself sets in and many patients waste away in domestic living rooms. A permanent immobilization of the patients takes effect, which otherwise could only be brought about by strong psychotropic drugs. Even if some patients express themselves positively about the state of permanent immobilization, it is questionable whether the established state can really be considered an improvement. In addition, the severe personality changes of those affected also often condition life in the family and society to the negative.