PSYCHOSURGERY - STEREOTAXIC SUBCAUDATE TRACTOTOMY - AN INDISPENSABLE TREATMENT

Background. Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliab le data are not available to prove the effectiveness of SST. A detaile d statement about contemporary psychosurgery is given. Method, Relevan t publications from the Unit and via Medline are discussed. The outcom e figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed question naires. Results. SST allows 40-60% of patients to live normal or near- normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% post-operatively, from 15% in cases of uncontrolled affective disorders is seen. Conclusion. As a treatment of last resor t, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.