Skip to main content Accessibility help

A Magnetic Resonance Imaging Study of Regional Cortical Volumes Following Stereotactic Anterior Cingulotomy

  • Scott L. Rauch, Nikos Makris, G. Rees Cosgrove, Hackjin Kim, Edwin H. Cassem, Bruce H. Price, Lee Baer, Cary R. Savage, Verne S. Caviness, Michael A. Jenike and David N. Kennedy...


The purpose of this study was to test the hypothesis that orbitofrontal cortical volume would be reduced following anterior cingulotomy for obsessive-compulsive disorder (OCD). Whole brain cortical parcellation was performed on magnetic resonance imaging (MRI) data from nine patients, before and 9(±6) months following anterior cingulotomy. No significant volumetric reductions were found in the orbitofrontal cortex. Exploratory findings of reduced volume in ventral temporo-fusiform and posterior cingulate regions were consistent with chance differences, in the face of multiple comparisons. Therefore, though the circumscribed lesions of anterior cingulotomy have recently been associated with corresponding volumetric reductions in the caudate nucleus, no comparable volumetric reductions are evident in cortical territories. Taken together, these results are most consistent with a model of cingulo-striatal perturbation as a putative mechanism for the efficacy of this procedure. While limitations in sensitivity may have also contributed to these negative findings, the methods employed have previously proven sufficient to detect cortical volumetric abnormalities in OCD. The current results may reflect a relatively diffuse pattern of cortico-cortical connections involving the neurons at the site of cingulotomy lesions. Future functional neuroimaging studies are warranted to assess possible cortical or subcortical metabolic changes associated with anterior cingulotomy, as well as predictors of treatment response.


Corresponding author

Please direct correspondence to: Scott L Rauch, MD, Department of Psychiatry, Massachusetts General Hospital–East, 9th Floor, Bldg. 149, 13th Street, Charlestown, MA 02129. Fax: 617.726.4078; Tel: 617.724.9553; e-mail:


Hide All
1.Cosgrove, GR, Rauch, SL. Psychosurgery. Neuwsurg Clin N Am. 1995;6:167176.
2.Baer, L, Rauch, SL, Ballantine, HT, et al.Cingulotomy for intractable obsessive-compulsive disorder: prospective long-term follow-up of 18 patients. Arch Gen Psychiatry. 1995;52:384392.
3.Spangler, WJ, Cosgrove, GR, Ballantine, HT, et al.Magnetic resonance image-guided stereotactic cingulotomy for intractable psychiatric disease. Neurosurgery. 1996;38:10711076.
4.Cohen, RA, Kaplan, RF, Moser, DJ, Jenkins, MA, Wilkinson, H. Impairments of attention after cingulotomy. Neurology. 1999;53:819824.
5.Corkin, S, Twitchell, TE, Sullivan, EV. Safety and efficacy of cingulotomy for pain and psychiatric disorder. In: Hitchcock, ER, Ballantine, HT, Meyerson, BA, eds. Modern Concepts in Psychiatric Surgery. New York, NY: Elsevier/North-Holland; 1979:253272.
6.Ochsner, KN, Kosslyn, SM, Cosgrove, GR, et al.Deficits in visual cognition and attention following bilateral anterior cingulotomy. Neuropsychologia. In press.
7.Rauch, SL, Kim, H, Makris, N, et al.Volume reduction in caudate nucleus following stereotactic lesions of anterior cingulate cortex in humans: a morphometric magnetic resonance imaging study. J Neuwsurg. 2000;93:10191025.
8.Rademacher, J, Galaburda, AM, Kennedy, DN, et al.Human cerebral cortex: localization, parcellation, and morphometry with magnetic resonance imaging. J Cog Neurosci. 1992;4:352374.
9.Caviness, VS, Kennedy, DN, Richelme, C, Rademacher, J, Filipek, PA. The human brain age 7-11 years: a volumetric analysis based upon magnetic resonance images. Cereb Cortex. 1996;6:726736.
10.Dejerine, J. Anatomie Des Centres Nerveux. Vol 2. Paris, France: Rueff et Cie; 1895.
11.Kaada, BR. Cingulate, posterior orbital, anterior insular and temporal pole cortex. In: Magoun, HW, ed. Neurophysiology. Baltimore, Md: Waverly Press; 1960:13451372.
12.Kaada, BR, Pribram, KH, Epstein, JA. Respiratory and vascular response in monkeys from temporal pole, insular, orbital surface and cingulate gyrus. J Neurophysiol. 1949;12:348356.
13.Pandya, DN, Van Hoesen, GW, Mesulam, MM. Efferent connections of the cingulate gyrus in the rhesus monkey. Exp Brain Res. 1981;42:319330.
14.Yakovlev, PI, Locke, S. Limbic nuclei of thalamus and connections of limbic cortex: Corticocortical connections of the anterior cingulate gyrus, the cingulum, and the subcallosal bundle in monkey. Arch Neurol. 1961;5:3470.
15.Saxena, S, Brody, AL, Schwartz, JM, Baxter, LR. Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry Suppl. 1998;35:2637.
16.Rauch, SL, Whalen, PJ, Dougherty, DD. Jenike, MA. Neurobiological models of obsessive compulsive disorders. In: Jenike, MA, Baer, L, Minichiello, WE, eds. Obsessive-Compulsive Disorders: Practical Management. Boston, Ma: Mosby; 1998:222253.
17.Baxter, LR, Schwartz, JM, Bergman, KS, et al.Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Schizophr Bull. Arch Gen Psychiatry. 1992;49:681689.
18.Schwartz, JM, Stoessel, PW, Baxter, LR, Martin, KM, Phelps, ME. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996;53:109113.
19.Goodman, WK, Price, LH, Rasmussen, SA, et al.The Yale-Brown Obsessive Compulsive Scale: Part I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46:10061011.
20.Ballantine, HT, Giriunas, IE. Treatment of intractable psychiatric illness and chronic pain by stereotactic cingulotomy. In: Schmidek, HH, Sweet, WH, eds. Operative Neurosurgical Techniques. New York, NY: Grune & Stratton; 1982:10691075.
21.Filipek, PA, Richelme, C, Kennedy, DN, Caviness, VS. The young adult human brain: an MRI-based morphometric analysis. Cereb Cortex. 1994;4:344360.
22.Cohen, J. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Lawrence Ehrlbaum; 1988.
23.Rauch, SL, Dougherty, DD, Cosgrove, GR, et al.Cerebral metabolic predictors of response to anterior cingulotomy for obsessive-compulsive disorder [abstract]. Biol Psychiatry. In press.
24.Vogt, BA, Pandya, DN. Cingulate cortex of the rhesus monkey: II. Cortical afferents. J Comp Neurol. 1987;262:271289.
25.Busatto, GF, Zamignani, DR, Buchpiguel, CA, et al.A voxel-based investigation of regional cerebral blood flow abnormalities in obsessive-compulsive disorder using single photon emission computed tomography (SPECT). Psychiatry Res. 2000;99:1527.
26.McGuire, PK, Bench, CJ, Frith, CD, Marks, IM, Frackowiak, RS, Dolan, RJ. Functional anatomy of obsessive-compulsive phenomena. Br J Psychiatry. 1994;164:459468.
27.Grachev, ID, Breiter, HC, Rauch, SL, et al.Structural abnormalities of frontal neocortex in obsessive-compulsive disorder. Arch Gen Psychiatry. 1998;55:181182.
28.Lippitz, BE, Mindus, P, Meyerson, BA, Kihlstrom, L, Lindquist, C. Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery. 1999;44:452460.
29.Nuttin, B, Cosyns, P, Demeulemeester, H, Gybels, J, Meyerson, B. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999;354:1526.
30.Nuttin, B, Gabriels, L, Cosyns, P, Gybels, J. Electrical stimulation of the brain for psychiatric disorders. CNS Spectrums. 2000;5:3539.
31.Greenberg, BD, George, MS, Martin, JD, et al.Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry. 1997;154:867869.

Related content

Powered by UNSILO

A Magnetic Resonance Imaging Study of Regional Cortical Volumes Following Stereotactic Anterior Cingulotomy

  • Scott L. Rauch, Nikos Makris, G. Rees Cosgrove, Hackjin Kim, Edwin H. Cassem, Bruce H. Price, Lee Baer, Cary R. Savage, Verne S. Caviness, Michael A. Jenike and David N. Kennedy...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.