Cingulotomy for Psychiatric Disease: Microelectrode Guidance, a Callosal Reference System for Documenting Lesion Location, and Clinical Results

Erich O. Richter, Karen D. Davis, Clement Hamani, William D. Hutchison, Jonathan O. Dostrovsky, Andres M. Lozano*, Björn Meyerson, Bart Nuttin, G. Rees Cosgrove, Joshua M. Rosenow, Ali R. Rezai

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

OBJECTIVE: To evaluate magnetic resonance imaging (MRI)- and microelectrode recording-guided cingulotomy for patients with psychiatric disorders and to develop a new method of mapping lesion location in anterior cingulate cortex that takes into account the significant interindividual variability in callosal morphometry. METHODS: MRI and microelectrode recording were used to guide placement of radiofrequency lesions in patients with obsessive-compulsive disorder (n = 21) or affective disorders (n = 5). Postoperative improvement was evaluated with the Yale-Brown Obsessive-Compulsive Scale in 15 of the 21 obsessive-compulsive disorder patients studied. From the postoperative MRI scans, we developed a coordinate system for position in the anterior cingulate cortex. The callosal line passes from the most anterior point of the corpus callosum (c = 0) to the most posterior (c = 100). We reconstructed the lesions onto a sagittal map from the Talairach and Tournoux atlas using the distance along the callosal line and the distance above the upper surface of the corpus callosum. RESULTS: The location of neuronal activity distinguished gray and white matter and was useful in delineating the upper and lower cortical banks of the cingulate gyrus, the cingulate bundle, and the corpus callosum. This information was used to place the lesions. Lesions typically were 6 to 8 mm in diameter on T2-weighted MRI scans. The inferior margins were along the corpus callosum from c = 16 to c = 38. Four of 15 patients with obsessive-compulsive disorder had a documented decrease of more than 35% on the Yale-Brown Obsessive-Compulsive Scale, but only one patient had a sustained benefit for more than 1 year. CONCLUSION: Microelectrode recording is useful for lesion placement. Our system for reporting location in anterior cingulate cortex normalizes for differences in callosal morphometry. These techniques may aid future study.

Original languageEnglish (US)
Pages (from-to)622-630
Number of pages9
JournalNeurosurgery
Volume54
Issue number3
DOIs
StatePublished - Mar 2004

Keywords

  • Anterior cingulate cortex
  • Cingulotomy
  • Magnetic resonance imaging
  • Microelectrode recording
  • Pain
  • Psychosurgery
  • Stereotactic surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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