Modern neurosurgery for psychiatric disorders

OBJECTIVE: The evolution, rationale, and results of modern functional neuro surgery to treat psychiatric disorders are documented. The potential benefi ts of neurosurgical treatment for selected, critically ill, psychiatric pat ients are considered. METHODS: The history, anatomic features, and evolution of and contemporary indications for the four currently used procedures (cingulotomy, subcaudate tractotomy, limbic leukotomy, and capsulotomy) are reviewed. Available out come, neuropsychological assessment, and functional imaging data are presen ted. RESULTS: Recently, there has been a renaissance of interest in the surgical treatment of psychiatric disease. Modern psychiatric neurosurgical procedu res are quite safe, with extremely low surgical mortality rates and transie nt postoperative morbidity. In selected cases, patients with conditions tha t had previously been completely refractory to comprehensive medical and be havioral intervention demonstrated significant improvement. This improvemen t was usually observed in the absence of long-term adverse neuropsychologic al consequences. CONCLUSION: Recent outcome studies, together with advances in neurobiology, psychiatry, functional imaging, and stereotaxy, support the further invest igation of modern functional neurosurgical procedures to treat psychiatric disorders and their application for a subset of psychiatric patients with c onditions refractory to all other therapies.