Bilateral Cingulotomy - Procedure

Procedure

In most cases the procedure starts with the medical team taking a number of CT scan X-ray images of the brain of the patient. This step ensures that the exact target, the cingulate cortex is mapped out, so that the surgeon can identify it. Then burr holes are created into the patient’s skull using a drill. Lesions at the targeted tissue are made with the help of fine electrodes inserted very carefully at the right angle into the subject’s brain based on plotting charts and making sure important arteries and blood vessels are intact. The electrode is placed in a probe, or a holder, with only its tip projecting. Upon the correct insertion of the holder into the brain tissue, air is injected and more scan images are taken. Then, after the medical team has made sure they are on the right track, the tip of the electrode is advanced to the plane of the cingulate where it is heated to 75-90 C. Once the first lesion is created it serves as a center around which several other lesions are created. In order to confirm whether lesions are made at the right place, scan images are taken postoperatively and analyzed.

Recent technological advances, however, have made bilateral cingulotomy a more precise operation. For example, nowadays a neurosurgical team that has to perform the procedure can use an MRI to identify the location of the anterior and posterior commissures. This approach allows neurosurgeons to obtain a number of coronal images, which are then used to calculate the stereotactic coordinates of the place in the anterior cingulate cortex, where lesions need to be created. Moreover the MRI enables to differentiate more precisely the cell composition, and thus easily identify the gray matter in that region. This can then be further confirmed with the help of microelectrode recordings.