Stereotactic Cingulotomy as a Means of Psychosurgery

摘要

Cingulotomy is a psychosurgical procedure designed to interrupt the interconnecting neuronal pathways of the brain involved in the regulation of the emotions and certain autonomic functions. The intent of psychosurgery has been defined as the modification or alternation of disturbances of behavior, thought content or mood for which no organic pathological cause can be demonstrated by established tests and techniques. The disorders that have been most frequently treated with bilateral anterior cingulotomy are chronic severe depressions unresponsive to othermodalities of treatment, marked anxiety, and obsessive-compulsive states. Although the immediate risks of stereotactic cingulotomy are quite low, the safety and efficacy of this procedure have not yet been rigorously evaluated in a comprehensive manner that might demonstrate the exact nature of clinical improvements to be expected in appropriately selected patients. Well designed studies that compare current forms of psychiatric surgery with clinical outcomes from other treatment modes are not available nor are well documented protocols to facilitate determination of a patient's 'intractability' to nonsurgical therapy. In the absence of such data, anterior cingulotomy as well as other psychosurgical procedures, must be considered to remain in the realm of research rather than accepted clinical practice.