Journal Mobile Options
Table of Contents
Vol. 84, No. 4, 2006
Issue release date: September 2006
Stereotact Funct Neurosurg 2006;84:184–189

Bilateral Anterior Cingulotomy for Refractory Obsessive-Compulsive Disorder: Long-Term Follow-Up Results

Jung H.H. · Kim C.-H. · Chang J.H. · Park Y.G. · Chung S.S. · Chang J.W.
Departments of aNeurosurgery and bPsychiatry, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Objective: To investigate the long-term efficacy and adverse cognitive effects of stereotactic bilateral anterior cingulotomy as a treatment for refractory obsessive-compulsive disorder (OCD) patients. Materials and Methods: Seventeen patients suffering from refractory OCD underwent stereotactic bilateral anterior cingulotomies and were followed for 24 months. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Clinical Global Impression and other neuropsychological tests were used to assess the efficacy and cognitive changes of cingulotomy. The tests were taken before and 12 and 24 months after surgery. Results: The mean improvement rate of the Y-BOCS score achieved from the baseline was 48%. Eight patients out of 17 met the responder criteria. During the 24-month follow-up, there were no significant adverse effects observed after surgery. Conclusions: Bilateral anterior cingulotomy was effective for the treatment of refractory OCD, and no other significant adverse cognitive effects on long-term follow-up were found.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Greenberg BD, Price LH, Rauch SL, Friehs G, Noren G, Malone D, Carpenter LL, Rezai AR, Rasmussen SA: Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin N Am 2003;14:199–212.
  2. Steketee G, Frost RO, Cohen I: Beliefs in obsessive-compulsive disorder. J Anxiety Disord 1998;12:525–537.
  3. Skoog G, Skoog I: A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry 1999;56:121–127.
  4. Baer L, Rauch SL, Ballantine HT Jr, Martuza R, Cosgrove R, Cassem E, Giriunas I, Manzo PA, Dimino C, Jenike MA: Cingulotomy for intractable obsessive-compulsive disorder: prospective long-term follow-up of 18 patients. Arch Gen Psychiatry 1995;52:384–392.
  5. Jenike MA, Baer L, Ballantine T, Martuza RL, Tynes S, Giriunas I, Buttolph ML, Cassem NH: Cingulotomy for refractory obsessive-compulsive disorder: a long-term follow-up of 33 patients. Arch Gen Psychiatry 1991;48:548–555.
  6. Dougherty DD, Baer L, Cosgrove GR, Cassem EH, Price BH, Nierenberg AA, Jenike MA, Rauch SL: Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry 2002;159:269–275.
  7. Jenike MA: Approaches to the patient with treatment-refractory obsessive-compulsive disorder. J Clin Psychiatry 1990;51(suppl):15–21.

    External Resources

  8. Kartsounis LD, Poynton A, Bridges PK, Bartlett JR: Neuropsychological correlates of stereotactic subcaudate tractotomy: a prospective study. Brain 1991;114:2657–2673.
  9. Hay P, Sachdev P, Cumming S, Smith JS, Lee T, Kitchener P, Matheson J: Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatr Scand 1993;87:197–207.
  10. Kim CH, Chang JW, Koo MS, Kim JW, Suh HS, Park IH, Lee HS: Anterior cingulotomy for refractory obsessive-compulsive disorder. Acta Psychiatr Scand 2003;107:283–290.
  11. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington DC, American Psychiatric Press, 1994.
  12. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS: The Yale-Brown Obsessive-Compulsive Scale. I. Development, use and reliability. Arch Gen Psychiatry 1989;46:1006–1011.
  13. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  14. Hamilton M: Standardized assessment and recording of depressive symptoms. Psychiatr Neurol Neurochir 1969;72:201–205.
  15. Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–55.
  16. Yum TH, Park YS, Oh KJ, Kim JK, Lee YH: Korean Wechsler Adult Intelligence Scale (K-WAIS) Manual. Seoul, Hankook Guidance, 1992.
  17. Meyers JE, Meyers KR: Rey Complex Figure Test and Recognition Trial: Professional Manual. Odessa, Psychological Association Resources Inc, 1995.
  18. Brandt J: The Hopkins Verbal Learning Test: development of a new memory test with six equivalent forms. Clin Neuropsychol 1991;5:125–142.
  19. Heaton RK: Wisconsin Card Sorting Test Manual. Odessa, Psychological Association Resources Inc, 1981.
  20. Spreen O, Benton AL: Neurosensory Center Comprehensive Examination for Aphasia. Victoria, Neuropsychology Laboratory, 1969.
  21. Wechsler E: WAIS-R Manual. New York, The Psychological Corporation, 1981.
  22. Vilkki J, Holst P: Speed and flexibility on word fluency tasks after focal brain lesions. Neuropsychologia 1994;32:1257–1262.
  23. Cosgrove GR, Ballantine HT: Cingulotomy in Psychosurgery. New York, McGraw-Hill, 1998.
  24. Ballantine HT Jr, Bouckoms AJ, Thomas EK, Giriunas IE: Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry 1987;22:807–819.
  25. Sachdev P, Trollor J, Walker A, Wen W, Fulham M, Smith JS, Matheson J: Bilateral orbitomedial leucotomy for obsessive-compulsive disorder: a single-case study using positron emission tomography. Aust NZ J Psychiatry 2001;35:684–690.
  26. Rauch SL, Dougherty DD, Cosgrove GR, Cassem EH, Alpert NM, Price BH, Nierenberg AA, Mayberg HS, Baer L, Jenike MA, Fischman AJ: Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive-compulsive disorder. Biol Psychiatry 2001;50:659–667.
  27. Rauch SL, Makris N, Cosgrove GR: A magnetic resonance imaging study of regional cortical volumes following stereotactic anterior cingulotomy. CNS Spectr 2001;6:214–222.
  28. Ballantine HT Jr: Neurosurgery for behavioral disorders; in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York, Elsevier/North-Holland Biomedical Press, 1985, pp 2527–2537.
  29. Cohen RA, Kaplan RF, Moser DJ, Jenkins MA, Wilkinson H: Impairments of attention after cingulotomy. Neurology 1999;53:819–824.
  30. Cohen RA, Kaplan RF, Zuffante P, Moser DJ, Jenkins MA, Salloway S, Wilkinson H: Alteration of intention and self-initiated action associated with bilateral anterior cingulotomy. J Neuropsychiatry Clin Neurosci 1999;11:444–453.
  31. Corkin S, Twitchell TE, Sullivan EV: Safety and efficacy of cingulotomy for pain and psychiatric disorder; in Hitchcock ER, Ballantine HT, Myerson BA (eds): Modern Concepts in Psychiatric Surgery. New York, Elsevier/North-Holland, 1979, pp 253–272.
  32. Lezak MD: Neuropsychological Assessments. New York, Oxford University Press, 1995.
  33. Ochsner KN, Kosslyn SM, Cosgrove GR, Cassem EH, Price BH, Nierenberg AA, Rauch SL: Deficits in visual cognition and attention following bilateral anterior cingulotomy. Neuropsychologia 2001;39:219–230.
  34. Corkin S: A prospective study of cingulotomy; in Valenstein ES (ed): The Psychosurgery Debate. San Francisco, Freeman & Co, 1980, pp 164–204.
  35. Ebert D, Ebmeier KP: The role of the cingulate gyrus in depression: from functional anatomy to neurochemistry. Biol Psychiatry 1996;39:1044–1050.
  36. Rauch SL, Whalen PJ, Dougherty D, Jenike MA: Neurobiologic models of obsessive-compulsive disorder; in Jenike MA, Baer L, Minichiello WE (eds): Obsessive-Compulsive Disorder: Practical Management. St Louis, Mosby, 1998, pp 222–253.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50