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Cingulotomy

Cingulotomy, where part of the anterior cingulate gyrus is destroyed, was pioneered in Great Britain in 1948 by Hugh Cairns, first Nuffield Professor of Surgery at the University of Oxford when it was found that severing fibres from the cingulated gyrus which pass through the anterior cingulate gyru led to an improvement in anxiety type states.

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.

The modern stereotactic procedure was introduced in 1967 and is performed by making a lesion 2 to 2.5 cm from the tip of the frontal horns, 7 mm lateral from the midline and 1 mm above the roof of the ventricles bilaterally. This is the most reported neurosurgical procedure for psychiatric diseases in the United States, compared to capsulotomy and limbic leucotomy being more prevalent in Europe.  In a controlled study involving 44 patients diagnosed with OCD only 32% met the criteria for having responded to the therapy.

It is thought that there is generally a delay to the onset of beneficial effect on OCD. This latency may be as long as six to twelve weeks, and it is the surgeons duty to clearly explain to the patient.

If there has been no response to the initial Cingulotomy after three to six months, then reoperation and enlargement of the Cingulotomy lesion is considered.

One report suggests that only about 1,000 procedures have been preformed for OCD patients, but none resulting in death. However, the haemorrhage rate is 0.3%, and other adverse effects include but are not limited to nausea, vomiting, and headaches. However, in some cases patients exhibit seizures and hydrocephalus that sometimes appear up to two months after the surgical intervention.   

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