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Contemporary psychosurgery.
1Departments of Neurosurgery and Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
Summary
Psychosurgery offers a safe and effective option for severe obsessive-compulsive disorder (OCD) and mood disorders when other treatments fail. Advances in brain imaging are improving understanding, but careful patient selection and multidisciplinary teams are crucial for optimal outcomes.
Area of Science:
- Neurosurgery
- Psychiatry
- Neuroscience
Background:
- Psychosurgery is a treatment option for intractable psychiatric disorders.
- Advances in functional brain imaging are enhancing the understanding of psychosurgery's biological basis.
- Optimal lesion site and size require further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of psychosurgery for specific psychiatric conditions.
- To discuss the current techniques, outcomes, and future directions of psychosurgery.
- To highlight the importance of patient selection, safeguards, and multidisciplinary care.
Main Methods:
- Stereotactic radiofrequency thermolesions and stereotactic radiosurgery are standard techniques.
- Lesion placement aims to minimize adverse effects like personality change, epilepsy, and cognitive decline.
- Outcomes are assessed, with reoperation considered for non-responders.
Main Results:
- Good outcomes are expected in 50-60% of cases.
- Approximately 40% may not benefit or experience adverse effects.
- Reliable predictive indicators for successful outcomes are currently lacking.
Conclusions:
- Psychosurgery remains a viable, though potentially underutilized, treatment for specific intractable psychiatric disorders.
- Strict ethical and regulatory safeguards, including multidisciplinary review, are mandatory.
- National centers with experienced teams and intensive rehabilitation are essential for best results.