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>Journals >Cirugía y Cirujanos >Year 2011, Issue 2

Jiménez-Ponce F, Soto-Abraham JE, Ramírez-Tapia Y, Velasco-Campos F, Carrillo-Ruiz JD, Gómez-Zenteno P
Evaluation of bilateral cingulotomy and anterior capsulotomy for the treatment of aggressive behavior
Cir Cir 2011; 79 (2)

Language: Español
References: 32
Page: 107-113
PDF: 337.47 Kb.

[Full text - PDF]


Background: Agressiveness is a psychiatric symptom that may be part of schizophrenia, mental retardation, drug abuse and other conditions. Surgical treatment remains controversial and few therapeutic options are available. We undertook this study to perform a prospective analysis on the efficacy and safety of bilateral cingulotomy and anterior capsulotomy in the treatment of aggressiveness behavior.
Methods: We studied 25 patients with a primary diagnosis of aggressiveness refractory to conventional treatment. Subjects were clinically evaluated with the Mayo-Portland adaptability inventory and the Global Assessment of Functioning score. Lesions were placed stereotactically in both targets and confirmed by postoperative magnetic resonance imaging. Significant changes were evaluated with Wilcoxon test after 3 and 6 months.
Results: According to inclusion and exclusion criteria, only 12 patients were finally included and surgical treated. Lesions significantly decreased using the Mayo-Portland adaptability inventory and the Global Assessment of Functioning score (p ‹0.002) at 3 and 6 months follow-up. Only five patients showed either mild or transitory postsurgical complications.
Conclusions: Combined bilateral anterior capsulotomy and cingulotomy successfully reduced aggressiveness behavior and improved clinical evaluations. These effects were obtained with fewer complications than previous described targets.

Key words: Aggressiveness, leucotomy, cingulotomy, capsulotomy, psychosurgery.


  1. Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986;143:35-39.

  2. Silver JM, Yudofsky SC. The Overt Aggression Scale: overview and guiding principles. J Neuropsychiatry Clin Neurosci 1991;3:22-29.

  3. American Psychiatric Association. Manual diagnóstico y estadístico de las enfermedades mentales (DSM IV-R). Barcelona: Masson; 2002. p. 1049.

  4. Taber KH, Hurley RA, Yudofsky SC. Diagnosis and treatment of neuropsychiatric disorders. Annu Rev Med 2010;61:121-133.

  5. Pedrosa-Sánchez M, Sola RG. Modern day psychosurgery: a new approach to neurosurgery in psychiatric disease. Rev Neurol 2003;36:887-897.

  6. Swartz MS, Swanson JW, Hiday VA, Borum R, Wagner HR, Burns BJ. Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. Am J Psychiatry 1998;155:226-231.

  7. Dieckmann G, Schneider-Jonietz B, Schneider H. Psychiatric and neuropsychological findings after stereotactic hypothalamotomy, in cases of extreme sexual aggressivity. Acta Neurochir Suppl 1988;44:163-166.

  8. Ramamurthi B. Stereotactic operation in behaviour disorders. Amygdalotomy and hypothalamotomy. Acta Neurochir Suppl 1988;44:152-157.

  9. Narabayashi H, Uno M. Long range results of stereotaxic amygdalotomy for behavior disorders. Confin Neurol 1966;27:168-171.

  10. Kiloh LG, Gye RS, Rushworth RG, Bell DS, White RT. Stereotactic amygdaloidotomy for aggressive behaviour. J Neurol Neurosurg Psychiatry 1974;37:437-444.

  11. Sano K, Yoshioka M, Ogashiwa M, Ishijima B, Ohye C. Postero-medial hypothalamotomy in the treatment of aggressive behaviors. Confin Neurol 1966;27:164-167.

  12. Schvarcz JR, Driollet R, Rios E, Betti O. Stereotactic hypothalamotomy for behaviour disorders. J Neurol Neurosurg Psychiatry 1972;35:356-359.

  13. Fulton JF, Jacobsen CF. The functions of the frontal lobes: a comparative study in monkeys, chimpanzees and man. Abstracts of the Second International Neurological Congress; 1935. pp. 61-73.

  14. Ballantine HT Jr, Bouckoms AJ, Thomas EK, Giriunas IE. Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry 1987;22:807-819.

  15. Spangler WJ, Cosgrove GR, Ballantine HT Jr, Cassem EH, Rauch SL, Nierenberg A, et al. Magnetic resonance image-guided stereotactic cingulotomy for intractable psychiatric disease. Neurosurgery 1996;38:1071-1076.

  16. Leksell L, Herner T, Leksell D, Persson B, Lindquist C. Visualisation of stereotactic radiolesions by nuclear magnetic resonance. J Neurol Neurosurg Psychiatry 1985;48:19-20.

  17. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 1951;102:316-319.

  18. Harvey PD, Mohs RC, Davidson M. Leukotomy and aging in chronic schizophrenia: a followup study 40 years after psychosurgery. Schizophr Bull 1993;19:723-732.

  19. Knight G. The orbital cortex as an objective in the surgical treatment of mental illness. The results of 450 cases of open operation and the development of the stereotactic approach. Br J Surg 1964;51:114-124.

  20. Moniz E. How I came to perform prefrontal leucotomy. Proceedings of The First International Psychosurgery Congress, Atica, Lisbon, August 4th-7th 1948.

  21. Kavoussi R, Armstead P, Coccaro E. The neurobiology of impulsive aggression. Psychiatr Clin North Am 1997;20:395-403.

  22. Anderson CA, Arciniegas DB. Neurosurgical interventions for neuropsychiatric syndromes. Curr Psychiatry Rep 2004;6:355-363.

  23. Binder DK, Iskandar BJ. Modern neurosurgery for psychiatric disorders. Neurosurgery 2000;47:9-21.

  24. Feldman RP, Goodrich JT. Psychosurgery: a historical overview. Neurosurgery 2001;48:647-657.

  25. Hansen H, Andersen R, Theilgaard A, Lunn V. Stereotactic psychosurgery. A psychiatric and psychological investigation of the effects and side effects of the interventions. Acta Psychiatr Scand Suppl 1982;301:1-123.

  26. Rafael H. Modern neurosurgery for psychiatric disorders. Neurosurgery 2001;48:1193-1194.

  27. Marino R, Cosgrove R. Neuropsychiatry of the basal ganglia. Psychiatr Clin North Am 1997;20:934-943.

  28. Rück C, Andréewitch S, Flyckt K, Edman G, Nyman H, Meyerson BA, et al. Capsulotomy for refractory anxiety disorders: long-term followup of 26 patients. Am J Psychiatry 2003;160:513-521.

  29. Velasco M, Lindsley DB. Role of orbital cortex in regulation of thalamocortical electrical activity. Science 1965;149:1375-1377.

  30. Best M, Williams JM, Coccaro EF. Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder. Proc Natl Acad Sci USA 2002;99:848-853.

  31. Eichelman B. The limbic system and aggression in humans. Neurosci Biobehav Rev 1983;7:391-394.

  32. Kelly D, Richardson A, Mitchell-Heggs N. Stereotactic limbic leucotomy:neurophysiological aspects and operative technique. Br J Psychiatry 1973;123:133-140.

>Journals >Cirugía y Cirujanos >Year 2011, Issue 2

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