Selective anterior cingulotomy: a psychosurgical evaluation

Abstract

In 1937 Papez '1 enunciated the theory that reverberant circuits in the limbic system supplied the mechanism to mediate and express emotional experience. In the years 1947-1951 Fulton' urged neurosurgeons to focus their attention on the anterior cingulum and medial orbital areas as optimum target zones for affective disorders; he pointed out that lesions in either region had no effect on learning disability in monkeys whereas ablations of the prefrontal convexity severely restricted this faculty. In 1958 MacLean s amplified the limbic circuits involved to include the medial forebrain bun~le. Ward 1~ predicted improvement in anancastic behavior from ablation experiments of area 24 in Macacques; he also observed widespread autonomic effects from stimulation of this area, as did Pool and Ransohoff. 1-~ These experimental observations were reinforced by clinical cases of cerebral tumors in the frontal and temporal lobes by Keschner, et al .? and Strauss and Keschner? ~ During the past decade, Malamud 9,1~ has stressed the relationship between psychotic states and the limbic system; recently he reported in detail 18 autopsied cases with limbic tumors. Many of his cases had epileptiform discharges and a clinical picture of schizophrenic or affective psychosis indistinguishable from the purely psychiatric form of these illnesses. These observations led neurosurgeons in various centers of the world to test the effect