Anterior cingulotomy for major depression: clinical outcome and relationship to lesion characteristics
Abstract
Background Anterior cingulotomy (ACING) is a neurosurgical treatment for chronic refractory depression, pain, and obsessive-compulsive disorder. Anterior cingulotomy involves the placement of bilateral lesions in the anterior cingulate under stereotactic guidance. Although a long-established therapeutic intervention, the optimal location and volume of lesions are not known, but it is generally believed that efficacious lesions interrupt the fibers of the cingulum bundle. Methods Using T2-weighted magnetic resonance imaging, we tested the hypothesis that lesions placed more anteriorly would be associated with a better clinical response. We also tested a secondary hypothesis that a superior clinical response would be associated with larger lesion volumes. Results When assessed 12 months following surgery, a superior clinical response was associated with more anterior lesions but, unexpectedly, with smaller lesion volumes. Specifically, the best clinical response was associated with total (right plus left hemisphere) lesion volumes of 1000 to 2000 mm(3) centered at Montreal Neurological Institute (MNI) coordinates (+/- 9,19,30). Conclusions There is considerable evidence from neuroimaging studies that more rostral areas within the anterior cingulate cortex are functionally and structurally abnormal in patients with major depressive disorder. Anteriorly placed ACING lesions would target and modify function within such regions. It should not be assumed that larger lesions are asso…
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Anterior cingulotomies compromise the cingulum but cause additional cortical damage, principally in area 24.
“The advent of computerised tomography and subsequent MR imaging, confirmed that although anterior cingulotomies do compromise the cingulum (Steele et al., 2008; Turner., 1973), they cause additional cortical damage, principally in area 24 (Spangler et al., 1996; Steele et al., 2008).”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Steele et al., 2008
In eight patients surgically treated for depression, performance on tests of executive function and memory, including block design, verbal fluency and digit span, appeared unaltered.
“Likewise, in eight patients surgically treated for depression, performance on tests of executive function and memory, including block design, verbal fluency and digit span, appeared unaltered (Steele et al., 2008).”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Steele et al., 2008
The same study found no deficits on the Trail Making Test after cingulotomy, although borderline deficits had previously been reported in a larger cohort of 18 cases.
“The same study (Steele et al., 2008) also found no deficits on the Trail Making Test, which taxes visual attention and task switching, although borderline deficits had previously been reported in a larger cohort of 18 cases (Cohen et al., 1999b).”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Steele et al., 2008
Lesions placed a little behind the genu were associated with better outcomes than those more caudal, at mid cingulate levels.
“This same study of 8 cases found that lesions placed a little behind the genu were associated with better outcomes than those more caudal, at mid cingulate levels (Steele et al., 2008; see also Corkin, 1980; Richter et al., 2004).”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Steele et al., 2008
There were improvements in paired-associate learning and spatial working memory after cingulotomy for depression.
“In addition, there were improvements in paired-associate learning and spatial working memory.”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Steele et al., 2008
A study of major depression found that smaller lesion volumes were associated with better results after cingulotomy.
“a study of major depression found that smaller lesion volumes were associated with better results (Steele et al., 2008).”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Steele et al., 2008
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References 31 · Cited by 131
- Authors
- Steele, J. D., Christmas, D., Eljamel, M. S., & Matthews, K.
- Affiliations
- University of Aberdeen (GB)
- University of Dundee (GB)
- Corresponding author
- Steele, J. Douglas
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 63
- Issue
- 7
- Pages
- 670-677
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2027768058
- Cited by
- 131
- References
- 31
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 8 · 2023: 8 · 2022: 10 · 2021: 7 · 2020: 3 · 2019: 8 · 2018: 6 · 2017: 1 · 2016: 10 · 2015: 7 · 2014: 11 · 2013: 6 · 2012: 5
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- anterior cingulotomy, major depressive disorder, treatment-resistant depression, anterior cingulate cortex, lesion localization, lesion volume, cingulum, stereotactic neurosurgery, placebo effect, treatment outcomes
- MeSH terms
- Adult, Depressive Disorder, Major, Major Depressive Disorder, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Male, Surveys and Questionnaires, Neurosurgical Procedures
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