Neuroanatomy, Cingulate Cortex - StatPearls - NCBI Bookshelf

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Bookshelf Search databaseBooksAll DatabasesAssemblyBiocollectionsBioProjectBioSampleBooksClinVarConserved DomainsdbGaPdbVarGeneGenomeGEO DataSetsGEO ProfilesGTRIdentical Protein GroupsMedGenMeSHNLM CatalogNucleotideOMIMPMCProteinProtein ClustersProtein Family ModelsPubChem BioAssayPubChem CompoundPubChem SubstancePubMedSNPSRAStructureTaxonomyToolKitToolKitAllToolKitBookghSearch termSearch

• Browse Titles
• Advanced
• Help
• Disclaimer

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

StatPearls [Internet].

Show detailsTreasure Island (FL): StatPearls Publishing; 2025 Jan-.Search term Neuroanatomy, Cingulate Cortex

Fareed R. Jumah; Rimal H. Dossani.

Author Information and Affiliations

Authors

Fareed R. Jumah1; Rimal H. Dossani2.

Affiliations

1 University of Missouri, Columbia, USA2 Louisiana State Un Health Sciences Cr

Last Update: December 6, 2022.

Introduction

The cingulate cortex is a fascinating area of the human brain that has been the subject of neuroanatomical and therapeutic investigation owing to its role in various functions and pathologies. It is a paired structure located on the medial surface of the cerebral hemisphere. It is perhaps best known as part of the limbic system (see Image. Principal Systems of Association Fibers in the Cerebrum). It is involved in many vital neural circuits, including the reward centers, amygdala, lateral prefrontal cortex, parietal cortex, motor areas, spinal cord, hippocampus, and limbic regions.[1] Although previously viewed as a mysterious territory of the brain, evidence from cognitive and fMRI studies has established a better understanding of the cingulate cortex in the last decade. Its functional role continues to be heavily studied to this day. The following sections provide further insight into the cingulate cortex's structure, function, and clinical and surgical significance.

Structure and Function

The cingulate cortex is made up of the cingulate gyrus and the cortical gray matter lining the superior and inferior borders of the cingulate sulcus (see Image. Cingulate Gyrus, Anatomy). As the Latin translation of "cingulate" would suggest, the cingulate gyrus wraps around the corpus callosum like a "belt." It begins beneath the rostrum of the corpus callosum, curves around the genu, and projects above the superior surface of the body of the corpus callosum, reaching its posterior end where it terminates at the isthmus of the cingulate gyrus. The isthmus is continuous inferiorly to the parahippocampal gyrus in the temporal lobe. The cingulate gyrus is separated from the corpus callosum inferiorly by the callosal sulcus and from the superior frontal gyrus superiorly by the cingulate sulcus.[2] See Image. Cingulate Gyrus. The cingulate cortex, therefore, reaches the cortical surface at no point in its trajectory. In the intact brain, it is enclosed by the exterior frontal, temporal, parietal, and occipital cerebral lobes.

The cingulate cortex divides into 4 functionally distinct regions: the anterior cingulate cortex (ACC), the midcingulate cortex, the posterior cingulate cortex (PCC), and the retrosplenial cortex.[3] The ACC comprises Brodmann's areas 24, 25, 32, and 33 and can be further subdivided into 3 subregions. The perigenual anterior cingulate cortex (pACC) primarily processes emotions and regulates endocrine and autonomic responses to them. The dorsal anterior cingulate cortex (dACC), also known as the midcingulate cortex, is thought to support cognitive processing, particularly reward-based decision-making.[4] The cingulate motor areas (CMA) are higher-order motor areas in the cortex, located within the cingulate sulcus next to the primary and supplementary motor cortices. The CMAs process information from our internal and external states (eg, emotional state signals from the limbic system) and translate them into motor commands executed by the primary and supplementary motor cortices and spinal cord.[5]

The PCC houses Brodmann's areas 23, 29, 30, and 31. The thick granular layer IV of the PCC marks a clear histologic distinction from the thin agranular layer IV of the ACC. The PCC consists of the posterior cingulate cortex proper (ventral and dorsal PCC), which is responsible for visuospatial orientation. Although contained within the PCC, the retrosplenial cortex is considered a distinct region of the cingulate cortex. It is implicated in imagination and the formation and consolidation of episodic memory.[6][7]

The cingulum, or cingulum bundle, is an important white matter tract that connects the orbitofrontal cortex to the temporal pole, forming a nearly complete ring beneath the cingulate gyrus.[8] It connects functionally diverse parts of the brain, including both cortical and subcortical structures. It thus facilitates an astounding variety of functions, including memory processes, visuospatial processing, emotional and behavioral regulation, and executive function.[9] Furthermore, it forms a crucial part of the so-called 'Papez circuit,' a fundamental connective network governing emotional function, linking the hippocampal formation, fornix, anterior thalamic nucleus, cingulum, and entorhinal cortex. This was originally proposed by the neuroanatomist James Papez, who theorized the need for a circuit connecting the hypothalamus, limbic lobe, and brainstem for emotional processing. MacLean later reclassified this in the context of the limbic system.[10] See Image. Mammillary Bodies. 

As seen from the extensive neural pathways it shares with other brain regions, the cingulate cortex can be considered, in a sense, a connecting hub of emotions, sensations, and action. Some of these pathways are involved in motivational processing, as evidenced by their connections with the orbitofrontal cortex, basal ganglia, and insula, which together form the brain's reward centers. Also, the cingulate cortex projects pathways to the lateral prefrontal cortex, which is involved in executive control, working memory, and learning. Pathways between the cingulate cortex and motor areas, such as the primary and supplementary motor cortices, the spinal cord, and the frontal eye fields, suggest an important role in motor control. Moreover, the cingulate cortex and the frontal and parietal lobes comprise a neural network for orienting attention, and, as expected, injury to any of these areas is known to cause hemineglect. The neural circuits the cingulate cortex shares with the hippocampus and the amygdala suggest roles in consolidating long-term memories and processing emotionally relevant stimuli, respectively.[11]

Embryology

During embryonic development, the prosencephalon (forebrain) gives rise to the telencephalon and diencephalon at around week 6. The telencephalon differentiates into the 2 cerebral hemispheres, which include the cingulate gyrus on their medial surface.

During early life and adolescent development, the functional connectivity of the cingulate cortex undergoes significant adaptive change. Interestingly, it appears that different functions ascribed to this anatomical area mature at different rates, with motor control and simple cognitive functions (eg, inhibition and attention) maturing in early childhood, whereas more complex emotional behaviors, such as social cognition, may mature as late as adolescence.[12]

Blood Supply and Lymphatics

The anterior cerebral artery supplies the majority of the medial surface of the cerebral hemisphere, including the cingulate gyrus. As a direct continuation of the anterior cerebral artery, the pericallosal artery travels within the callosal sulcus and gives off many small cortical branches that supply the rostrum of the cingulate gyrus. The callomarginal artery, the largest branch of the anterior cerebral artery, runs within the cingulate sulcus and supplies the portion of the cingulate gyrus underlying the paracentral lobule. Posteriorly, the precuneus and posterior cingulate gyrus receive vascular supply from the precuneal artery, a branch of the pericallosal artery.[13]

Physiologic Variants

Some of the normal anatomic variations of the cingulate gyrus include a single cingulate sulcus or double parallel cingulate sulci. MRI volumetric studies of normal brains showed no significant volume asymmetries between the left and right hemispheres, except in the cingulate gyrus, which was larger on the left. Pujol et al studied the brains of 100 healthy subjects and found that a larger right ACC was more frequent in females than in males.[3] Interestingly, subjects with a larger right ACC had more worrisome personalities, greater fear in the face of uncertainty, and shyness around strangers.[14] In light of physiological variations in the size and morphology of the cingulate cortex between individuals, it has also been hypothesized that this anatomical variability may underlie differences in response to surgical intervention in this area.[15]

Surgical Considerations

Bilateral anterior cingulotomy is a neurosurgical procedure that can be performed for chronic refractory depression, pain, or obsessive-compulsive disorder. It involves stereotactic ablation of the bilateral anterior cingulate gyri, thus severing the supracallosal fibers of the cingulum.[16] It is commonly used to treat chronic pain refractory to medications, as in patients with metastatic cancer. This procedure is thought to reduce the unpleasant perception of pain rather than eliminate the pain itself.

In the context of the treatment of refractory depression, a better clinical response was observed in patients who had relatively anteriorly placed lesioning of their ACC, in line with neuroimaging studies demonstrating that patients with major depression have anatomical abnormalities compared to the healthy population in the rostral part of the cingulate cortex.[15] Counterintuitively, patients with small lesions in this area experienced better responses, challenging the assumption that larger lesions confer greater clinical benefits.

In the treatment of obsessive-compulsive disorder, the target is the dorsal ACC, and better clinical outcomes have been observed following lesioning of the superior part of the cingulate cortex here, as measured by the Yale-Brown Obsessive-Compulsive Scale (YBOCS) score.[17] A large meta-analysis of studies reporting outcomes of surgical treatment for obsessive-compulsive disorder found a mean reduction of 37% in the YBOCS score following cingulotomy.[18] Furthermore, neuroimaging studies of patients who responded well to cingulotomy found that they tended to have lesions in the posterior part of Brodmann area 32, and that, in those who did not respond initially, a second lesion surgery can be beneficial for clinical outcomes.[17][19] In general, a greater reduction (55%) in the YBOCS score was observed in patients undergoing capsulotomy, a procedure in which the anterior limb of the internal capsule is lesioned rather than the cingulate cortex.[20] However, the serious adverse effects associated with cingulotomy were much lower compared to those associated with capsulotomy (5.25 and 21.4%, respectively)[18]

Clinical Significance

Subfalcine Herniation

Owing to the anatomical organization of the brain within a fixed compartment (the bony cranium) and subdivided by dural reflections (the falx cerebri and tentorium cerebelli), it is vulnerable to damage from an increase in intracranial pressure (ICP).[21] This may be caused by an increased amount of intracranial cerebrospinal fluid (ie, hydrocephalus), a hematoma in the extradural, subdural, subarachnoid, or intraparenchymal spaces, a space-occupying lesion, or edema from a disease process.[22] Following an increase in ICP, the brain can herniate between the spaces bound by the dural reflections, causing corresponding neurological damage to the structures involved.

The most common brain herniation syndrome is subfalcine herniation, in which raised ICP forces a cerebral hemisphere to the opposite side of the cranium, forcing the cingulate gyrus beneath the free edge of the falx cerebri.[23] This happens anteriorly because the falx cerebri is rigid posteriorly, so the herniation occurs preferentially anteriorly, where there is less resistance from the falx cerebri (see Image. Compression of the Pericallosal Artery).[24] Although it does not usually produce severe symptomatology, if subfalcine herniation progresses, it can be further complicated by compression of the anterior cerebral artery (ACA) against the falx, resulting in an ipsilateral ACA stroke, which most commonly manifests as contralateral leg weakness.[25]

Schizophrenia

Given the complexity of higher cognitive functions and the extensive connections of the cingulate cortex with other brain regions, it is not surprising that it plays a role in the pathogenesis of schizophrenia. This finding has been confirmed in post-mortem anatomical studies.[26] In particular, the ACC is 1 of the brain areas that shows abnormalities in schizophrenic patients when compared to healthy subjects. These anomalies include reduced cortical grey matter, decreased gyrus volume, and disrupted neuronal arrangement, particularly in the anterior segment of the cingulate gyrus. At the cellular level, reduced neuronal size and glial density are observed in this region.[27][28] The relevance of these morphological findings to clinical practice and future therapeutic interventions relevant to schizophrenia remains to be elucidated and requires further detailed neuroimaging studies and clinical trials.

Review Questions

• Access free multiple choice questions on this topic.
• Comment on this article.

Figure

Principal Systems of Association Fibers in the Cerebrum. This diagram shows the principal systems of association fibers in the cerebrum, short fibers, superior longitudinal fascia, cingulum, corpus callosum, uncinate fascia, inferior longitudinal fascia, (more...)

Figure

Mammillary Bodies. Panel A shows the mammillary bodies on the ventral surface of the brain. Panel B illustrates the Papez circuit. Panel C depicts the mammillary bodies (gray) and their primary pathways: the fornix conveying input from the hippocampus (more...)

Figure

Cingulate Gyrus, Anatomy Contributed by S Bhimji, MD

Figure

Compression of the Pericallosal Artery. The illustration shows compression of the pericallosal artery (arrow) against the falx cerebri due to a subfalcine hernia. Gilardi BR, López JIM, Hernández Villegas AC, et al. Types (more...)

Figure

Cingulate Gyrus Contributed by S Munakomi, MD

References

1.Rolls ET. The cingulate cortex and limbic systems for action, emotion, and memory. Handb Clin Neurol. 2019;166:23-37. [PubMed: 31731913]2.Stevens FL, Hurley RA, Taber KH. Anterior cingulate cortex: unique role in cognition and emotion. J Neuropsychiatry Clin Neurosci. 2011 Spring;23(2):121-5. [PubMed: 21677237]3.Vogt BA, Nimchinsky EA, Vogt LJ, Hof PR. Human cingulate cortex: surface features, flat maps, and cytoarchitecture. J Comp Neurol. 1995 Aug 28;359(3):490-506. [PubMed: 7499543]4.Vogt BA. Midcingulate cortex: Structure, connections, homologies, functions and diseases. J Chem Neuroanat. 2016 Jul;74:28-46. [PubMed: 26993424]5.Strick PL, Dum RP, Picard N. Motor areas on the medial wall of the hemisphere. Novartis Found Symp. 1998;218:64-75; discussion 75-80, 104-8. [PubMed: 9949816]6.Vogt BA, Laureys S. Posterior cingulate, precuneal and retrosplenial cortices: cytology and components of the neural network correlates of consciousness. Prog Brain Res. 2005;150:205-17. [PMC free article: PMC2679949] [PubMed: 16186025]7.Leech R, Sharp DJ. The role of the posterior cingulate cortex in cognition and disease. Brain. 2014 Jan;137(Pt 1):12-32. [PMC free article: PMC3891440] [PubMed: 23869106]8.Weininger J, Roman E, Tierney P, Barry D, Gallagher H, Murphy P, Levins KJ, O'Keane V, O'Hanlon E, Roddy DW. Papez's Forgotten Tract: 80 Years of Unreconciled Findings Concerning the Thalamocingulate Tract. Front Neuroanat. 2019;13:14. [PMC free article: PMC6388660] [PubMed: 30833890]9.Bubb EJ, Metzler-Baddeley C, Aggleton JP. The cingulum bundle: Anatomy, function, and dysfunction. Neurosci Biobehav Rev. 2018 Sep;92:104-127. [PMC free article: PMC6090091] [PubMed: 29753752]10.Rajmohan V, Mohandas E. The limbic system. Indian J Psychiatry. 2007 Apr;49(2):132-9. [PMC free article: PMC2917081] [PubMed: 20711399]11.Hayden BY, Platt ML. Neurons in anterior cingulate cortex multiplex information about reward and action. J Neurosci. 2010 Mar 03;30(9):3339-46. [PMC free article: PMC2847481] [PubMed: 20203193]12.Kelly AM, Di Martino A, Uddin LQ, Shehzad Z, Gee DG, Reiss PT, Margulies DS, Castellanos FX, Milham MP. Development of anterior cingulate functional connectivity from late childhood to early adulthood. Cereb Cortex. 2009 Mar;19(3):640-57. [PubMed: 18653667]13.Cilliers K, Page BJ. Review of the Anatomy of the Distal Anterior Cerebral Artery and Its Anomalies. Turk Neurosurg. 2016;26(5):653-61. [PubMed: 27337235]14.Pujol J, López A, Deus J, Cardoner N, Vallejo J, Capdevila A, Paus T. Anatomical variability of the anterior cingulate gyrus and basic dimensions of human personality. Neuroimage. 2002 Apr;15(4):847-55. [PubMed: 11906225]15.Steele JD, Christmas D, Eljamel MS, Matthews K. Anterior cingulotomy for major depression: clinical outcome and relationship to lesion characteristics. Biol Psychiatry. 2008 Apr 01;63(7):670-7. [PubMed: 17916331]16.Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin N Am. 2003 Apr;14(2):225-35. [PubMed: 12856490]17.Starkweather CK, Bick SK, McHugh JM, Dougherty DD, Williams ZM. Lesion location and outcome following cingulotomy for obsessive-compulsive disorder. J Neurosurg. 2022 Jan 01;136(1):221-230. [PMC free article: PMC10193485] [PubMed: 34243154]18.Brown LT, Mikell CB, Youngerman BE, Zhang Y, McKhann GM, Sheth SA. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg. 2016 Jan;124(1):77-89. [PubMed: 26252455]19.Bourne SK, Sheth SA, Neal J, Strong C, Mian MK, Cosgrove GR, Eskandar EN, Dougherty DD. Beneficial effect of subsequent lesion procedures after nonresponse to initial cingulotomy for severe, treatment-refractory obsessive-compulsive disorder. Neurosurgery. 2013 Feb;72(2):196-202; discussion 202. [PubMed: 23147780]20.Rück C, Karlsson A, Steele JD, Edman G, Meyerson BA, Ericson K, Nyman H, Asberg M, Svanborg P. Capsulotomy for obsessive-compulsive disorder: long-term follow-up of 25 patients. Arch Gen Psychiatry. 2008 Aug;65(8):914-21. [PubMed: 18678796]21.Tayebi Meybodi A, Tabani H, Benet A. Arachnoid and dural reflections. Handb Clin Neurol. 2020;169:17-54. [PubMed: 32553288]22.Leinonen V, Vanninen R, Rauramaa T. Raised intracranial pressure and brain edema. Handb Clin Neurol. 2017;145:25-37. [PubMed: 28987174]23.Riveros Gilardi B, Muñoz López JI, Hernández Villegas AC, Garay Mora JA, Rico Rodríguez OC, Chávez Appendini R, De la Mora Malváez M, Higuera Calleja JA. Types of Cerebral Herniation and Their Imaging Features. Radiographics. 2019 Oct;39(6):1598-1610. [PubMed: 31589570]24.Johnson PL, Eckard DA, Chason DP, Brecheisen MA, Batnitzky S. Imaging of acquired cerebral herniations. Neuroimaging Clin N Am. 2002 May;12(2):217-28. [PubMed: 12391633]25.Byard RW. Patterns of cerebral and cerebellar herniation. Forensic Sci Med Pathol. 2013 Jun;9(2):260-4. [PubMed: 22544455]26.Wang L, Hosakere M, Trein JC, Miller A, Ratnanather JT, Barch DM, Thompson PA, Qiu A, Gado MH, Miller MI, Csernansky JG. Abnormalities of cingulate gyrus neuroanatomy in schizophrenia. Schizophr Res. 2007 Jul;93(1-3):66-78. [PMC free article: PMC1976383] [PubMed: 17433626]27.Baiano M, David A, Versace A, Churchill R, Balestrieri M, Brambilla P. Anterior cingulate volumes in schizophrenia: a systematic review and a meta-analysis of MRI studies. Schizophr Res. 2007 Jul;93(1-3):1-12. [PubMed: 17399954]28.Benes FM, Bird ED. An analysis of the arrangement of neurons in the cingulate cortex of schizophrenic patients. Arch Gen Psychiatry. 1987 Jul;44(7):608-16. [PubMed: 3606326]

Disclosure: Fareed Jumah declares no relevant financial relationships with ineligible companies.

Disclosure: Rimal Dossani declares no relevant financial relationships with ineligible companies.

Copyright © 2025, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Bookshelf ID: NBK537077PMID: 30725762 Share

Views

• PubReader
• Print View
• Cite this PageJumah FR, Dossani RH. Neuroanatomy, Cingulate Cortex. [Updated 2022 Dec 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

In this Page

• Introduction
• Structure and Function
• Embryology
• Blood Supply and Lymphatics
• Physiologic Variants
• Surgical Considerations
• Clinical Significance
• Review Questions
• References

Related information

• PMCPubMed Central citations
• PubMedLinks to PubMed

Similar articles in PubMed

• Short-Term Memory Impairment.[StatPearls. 2025]Short-Term Memory Impairment.Asuncion RMD, Al Khalili Y. StatPearls. 2025 Jan
• Mid Forehead Brow Lift(Archived).[StatPearls. 2025]Mid Forehead Brow Lift(Archived).Patel BC, Malhotra R. StatPearls. 2025 Jan
• Charles Bonnet Syndrome.[StatPearls. 2025]Charles Bonnet Syndrome.Mars JA, Rojas LC, Gurnani B. StatPearls. 2025 Jan
• Review Aspects of Genetic Diversity, Host Specificity and Public Health Significance of Single-Celled Intestinal Parasites Commonly Observed in Humans and Mostly Referred to as 'Non-Pathogenic'.[APMIS. 2025]Review Aspects of Genetic Diversity, Host Specificity and Public Health Significance of Single-Celled Intestinal Parasites Commonly Observed in Humans and Mostly Referred to as 'Non-Pathogenic'.Stensvold CR. APMIS. 2025 Sep; 133(9):e70036.
• Review The cingulum: anatomy, connectivity and what goes beyond.[Brain Commun. 2025]Review The cingulum: anatomy, connectivity and what goes beyond.Kollenburg L, Arnts H, Green A, Strauss I, Vinke S, Kurt E. Brain Commun. 2025; 7(1):fcaf048. Epub 2025 Jan 31.

See reviews...See all...

Recent Activity

ClearTurn OffTurn On

• Neuroanatomy, Cingulate Cortex - StatPearlsNeuroanatomy, Cingulate Cortex - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more... Follow NCBI Twitter Facebook LinkedIn GitHub NCBI Insights Blog

Connect with NLM

• Twitter
• Facebook
• Youtube

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

• NLM
• NIH
• HHS
• USA.gov