Treating OCD and Depression With Bilateral Cingulotomy

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Bilateral cingulotomy is a type of brain surgery considered a last resort for people withobsessive-compulsive disorder(OCD). It is also used to treat major depression and occasionally chronic pain for persons who haven’t found relief from any other form of therapy.

This surgery targets two parts of the brain:

Surgical procedures in psychiatry are controversial, and most doctors will not perform a bilateral cingulotomy unless all other avenues of treatment have been exhausted. Many neurosurgeons, in fact, will require consent from both the patient and a close family member before proceeding with the operation.

Rationale for Bilateral Cingulotomy

The cingulate gyrus serves a unique purpose in the brain, connecting experiences and sensations to either pleasant or unpleasant memory. Among other things, it induces an emotional response to pain and can connect that response to one or more of our senses (sight, smell, taste, touch, sound). The cingulate gyrus also completes the circuit to another part of the brain called the caudate nucleus, whose function it is to form habits.

How the Surgery Is Performed

Recovery from the operation takes around four days. Side effects are generally mild, with some experiencing headache, nausea, and vomiting in the days following the surgery. The surgery may also trigger seizures in some, although this typically happens in those with a previous history of seizures.

Some people complain of apathy following surgery, while others will experience memory lapses. These are uncommon side effects, but potential risks that candidates of the surgery would need to consider.

Effectiveness of Bilateral Cingulotomy

Bilateral cingulotomy appears to be least effective in persons with treatment-refractory OCD.Treatment-refractory OCDis diagnosed in persons who have achieved little if any response to at least two differentselective serotonin reuptake inhibitor (SSRI) drugs. It is also seen to be less useful in persons with more severe manifestations of the disorder, including OCD-related hoarding.

While some studies have proposed bilateral cingulotomy for persons with treatment-resistant bipolar disorder, studies have thus far been inconclusive. As such, it is currently not endorsed as a means ofbipolar treatment.

4 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Agarwal N, Choi PA, et al.Anterior cingulotomy for intractable pain.Interdisciplinary Neurosurgery. 2016;(6):80-83.  doi:10.1016/j.inat.2016.10.005Volpini M, Giacobbe P, Cosgrove GR, Levitt A, Lozano AM, Lipsman N.The History and Future of Ablative Neurosurgery for Major Depressive Disorder.Stereotact Funct Neurosurg. 2017;95(4):216-228.  doi:10.1159/000478025Brown LT, Mikell CB, Youngerman BE, Zhang Y, Mckhann GM, Sheth SA.Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies.J Neurosurg. 2016;(124)1:77-89. doi:10.3171/2015.1.JNS14681Sharim J, Pouratian N.Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review.Pain Physician. 2016;(19)8:537-550.Additional ReadingBrown, L.; Mikell, C.; Youngerman, B.; et al. “Dorsal Anterior Cingulotomy and Anterior Capsulotomy for Severe,Refractory Obsessive-Compulsive Disorder: A Systematic Review of Observational Studies.“Journal of Neurosurgery. 2016; 124(1):77-89.Gentil, A.; Lopes, A.; Dougherty, D.; et al. “Hoarding Symptoms and Prediction of Poor Response toLimbic System Surgery for Treatment-Refractory Obsessive-Compulsive Disorder.“Journal of Neurosurgery. 2014; 121(1):123-30.Shah, D.; Pesiridou, A.; Baltuch, G.; et al. “FunctionalNeurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician.“Psychiatry. 2008; 5(9):24-33.Zhang, Q.; Wang, W.; and X. Wei. “Long-Term Efficacy of Stereotactic Bilateral Anterior Cingulotomy and Bilateral Anterior Capsulotomy as aTreatment for Refractory Obsessive-Compulsive Disorder.“Stereotactic and Functional Neurosurgery. 2013; 91(4):258-61.

4 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Agarwal N, Choi PA, et al.Anterior cingulotomy for intractable pain.Interdisciplinary Neurosurgery. 2016;(6):80-83.  doi:10.1016/j.inat.2016.10.005Volpini M, Giacobbe P, Cosgrove GR, Levitt A, Lozano AM, Lipsman N.The History and Future of Ablative Neurosurgery for Major Depressive Disorder.Stereotact Funct Neurosurg. 2017;95(4):216-228.  doi:10.1159/000478025Brown LT, Mikell CB, Youngerman BE, Zhang Y, Mckhann GM, Sheth SA.Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies.J Neurosurg. 2016;(124)1:77-89. doi:10.3171/2015.1.JNS14681Sharim J, Pouratian N.Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review.Pain Physician. 2016;(19)8:537-550.Additional ReadingBrown, L.; Mikell, C.; Youngerman, B.; et al. “Dorsal Anterior Cingulotomy and Anterior Capsulotomy for Severe,Refractory Obsessive-Compulsive Disorder: A Systematic Review of Observational Studies.“Journal of Neurosurgery. 2016; 124(1):77-89.Gentil, A.; Lopes, A.; Dougherty, D.; et al. “Hoarding Symptoms and Prediction of Poor Response toLimbic System Surgery for Treatment-Refractory Obsessive-Compulsive Disorder.“Journal of Neurosurgery. 2014; 121(1):123-30.Shah, D.; Pesiridou, A.; Baltuch, G.; et al. “FunctionalNeurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician.“Psychiatry. 2008; 5(9):24-33.Zhang, Q.; Wang, W.; and X. Wei. “Long-Term Efficacy of Stereotactic Bilateral Anterior Cingulotomy and Bilateral Anterior Capsulotomy as aTreatment for Refractory Obsessive-Compulsive Disorder.“Stereotactic and Functional Neurosurgery. 2013; 91(4):258-61.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Agarwal N, Choi PA, et al.Anterior cingulotomy for intractable pain.Interdisciplinary Neurosurgery. 2016;(6):80-83.  doi:10.1016/j.inat.2016.10.005Volpini M, Giacobbe P, Cosgrove GR, Levitt A, Lozano AM, Lipsman N.The History and Future of Ablative Neurosurgery for Major Depressive Disorder.Stereotact Funct Neurosurg. 2017;95(4):216-228.  doi:10.1159/000478025Brown LT, Mikell CB, Youngerman BE, Zhang Y, Mckhann GM, Sheth SA.Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies.J Neurosurg. 2016;(124)1:77-89. doi:10.3171/2015.1.JNS14681Sharim J, Pouratian N.Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review.Pain Physician. 2016;(19)8:537-550.

Agarwal N, Choi PA, et al.Anterior cingulotomy for intractable pain.Interdisciplinary Neurosurgery. 2016;(6):80-83.  doi:10.1016/j.inat.2016.10.005

Volpini M, Giacobbe P, Cosgrove GR, Levitt A, Lozano AM, Lipsman N.The History and Future of Ablative Neurosurgery for Major Depressive Disorder.Stereotact Funct Neurosurg. 2017;95(4):216-228.  doi:10.1159/000478025

Brown LT, Mikell CB, Youngerman BE, Zhang Y, Mckhann GM, Sheth SA.Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies.J Neurosurg. 2016;(124)1:77-89. doi:10.3171/2015.1.JNS14681

Sharim J, Pouratian N.Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review.Pain Physician. 2016;(19)8:537-550.

Brown, L.; Mikell, C.; Youngerman, B.; et al. “Dorsal Anterior Cingulotomy and Anterior Capsulotomy for Severe,Refractory Obsessive-Compulsive Disorder: A Systematic Review of Observational Studies.“Journal of Neurosurgery. 2016; 124(1):77-89.Gentil, A.; Lopes, A.; Dougherty, D.; et al. “Hoarding Symptoms and Prediction of Poor Response toLimbic System Surgery for Treatment-Refractory Obsessive-Compulsive Disorder.“Journal of Neurosurgery. 2014; 121(1):123-30.Shah, D.; Pesiridou, A.; Baltuch, G.; et al. “FunctionalNeurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician.“Psychiatry. 2008; 5(9):24-33.Zhang, Q.; Wang, W.; and X. Wei. “Long-Term Efficacy of Stereotactic Bilateral Anterior Cingulotomy and Bilateral Anterior Capsulotomy as aTreatment for Refractory Obsessive-Compulsive Disorder.“Stereotactic and Functional Neurosurgery. 2013; 91(4):258-61.

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