It was suggested by American physiologist John Farquhar Fulton who, at a meeting of the Society of British Neurosurgeons in 1947, said "were it feasible, cingulotomy in man would seem an appropriate place for limited leucotomy".
This was derived from the hypothesis of James Papez who thought that the cingulum was a major component of an anatomic circuit believed to play a significant role in emotion.
[7] The first reports of the use of cingulotomy on psychiatric patients came from J le Beau in Paris, Hugh Cairns in Oxford, and Kenneth Livingston in Oregon.
In addition, neuroimaging studies also indicated that the anterior cingulate cortex participates in the modulation of cortical regions that are of higher order, as well as sensory processing areas.
[10] These findings have also been confirmed by stereotactic microelectrode analysis of single cortical neurons in a study, which involved nine patients undergoing bilateral cingulotomy.
These studies showed that the caudal part of the anterior cingulate cortex plays a more important function in cognitive activities that involve attention, salience, interference and response competition.
[10] These results, combined with electrophysiological investigation of the function of neurons in the anterior cingulate cortex, have provided insights that can be used in the improvement of cingulotomy performed on patients treated for obsessive–compulsive disorder (OCD).
[11] The function of this part of the human brain has been mapped to be composed of fiber tracks associated with numerous parallel cortico-striato-thalamocortical circuits (CSTC), which are involved in sensorimotor, motor, oculomotor as well as the cognitive processes that are manifested by the limbic system.
[13] The results showed a significant decrease in intracortical inhibition, which resulted in a slowdown of interstimulus intervals by 3 ms.[13] In addition to its proximity to and association with the limbic system and the amygdala in particular, which plays a key role in emotional experience, the anterior cingulate cortex shares afferent and efferent pathways with a number of thalamic nuclei as well as the posterior cingulate and part of some parietal, frontal and supplementary motor cortex.
Functional MRI analyses of the anterior cingulate cortex have also led to the introduction of bilateral cingulotomy for the treatment of chronic pain.
In most cases the procedure started with the medical team taking a number of CT scan X-ray images of the brain of the patient.
Lesions at the targeted tissue were made with the help of fine electrodes inserted at the right angle into the subject's brain based on plotting charts and making sure important arteries and blood vessels were intact.
This approach allows neurosurgeons to obtain a number of coronal images, which are then used to calculate the stereotactic coordinates of the target in the anterior cingulate cortex, where lesions need to be made.
The mild shorter postoperative complications that are most commonly related to bilateral cingulotomy are typical of head interventions and include but are not limited to nausea, vomiting, and headaches.
[19] A 2002 study conducted at the Massachusetts General Hospital analyzed the outcome of bilateral cingulotomy in 44 patients for the treatment of OCD in the period between 1965 and 1986.