MAGNETIC-RESONANCE IMAGE-GUIDED STEREOTAXIC CINGULOTOMY FOR INTRACTABLE PSYCHIATRIC DISEASE

WE DESCRIBE THE modern operative technique of magnetic resonance (MR) image-guided stereotactic cingulotomy and discuss the indications, res ults, and complications of this procedure. A retrospective analysis of psychiatric outcome was performed for 34 patients with intractable ma jor affective disorder and/or obsessive-compulsive disorder who underw ent MR image-guided stereotactic cingulotomy since 1991. Fourteen pati ents underwent multiple cingulotomies (50 total procedures). Overall, 38% of the patients were classified as responders, 23% as possible res ponders, and 38% as nonresponders. Of the patients who did not respond to initial cingulotomies and who underwent multiple cingulotomies, 36 % became responders, 36% possible responders, and 28% nonresponders. T here were no deaths or long-term side effects related to the procedure . The therapeutic results of MR image-guided stereotactic cingulotomy are similar to the results of earlier methods of cingulotomy, and the use of MR imaging offers substantial technical advantages. This proced ure also compares favorably with other neurosurgical procedures perfor med for intractable psychiatric disease with a low rate of undesired s ide effects. Cingulotomy is safe and well tolerated, with over one-thi rd of the patients demonstrating significant improvement; however, pro spective long-term follow-up studies are needed to further define the role of surgery in treating intractable psychiatric disease.