Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-20T04:05:43.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgery for Psychiatric Disorders

Published online by Cambridge University Press:  07 November 2014

G. Rees Cosgrove
Get access Rights & Permissions [Opens in a new window]

Abstract

The modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.

Type
Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 10: Neurosurgical Approaches and Deep Brain Implants in Neuropsychiatric Illness: Part One , October 2000 , pp. 43 - 52
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Tooth, JC, Newton, MP. Leucotomy in England and Wales 1942-1954. Reports on public health and medical subjects. No 104. London, United Kingdoms: Her Majesty's Stationary Office; 1961.Google Scholar
2.Moniz, E. Prefrontal leucotomy in the treatment of mental disorders. Am J Psychiatry. 1937;93:1379–1385.CrossRefGoogle Scholar
3.Fulton, JF, Jacobsen, CF. Fonctions des lobes frontaux; etude comparee chez l'homme et les singes chimpanzes. Proceedings of the International Neurological Congress. London; 1935: 552.Google Scholar
4.Valenstein, ES. Great and Desperate Cures. The Rise and Fall of Psychosurgery and Other Radical Treatments for Mental Illness. New York, NY: Basic Books; 1986.Google Scholar
5.Freeman, W, Watts, JW. Psychosurgical in the Treatment of Mental Disorders and Intractable Pain. Springfield, [MASS?]: Charles C Thomas; 1950.Google Scholar
6.Freeman, W. Transorbital leucotomy. Lancet. 1948;2:371–373.CrossRefGoogle ScholarPubMed
7.Foltz, EL, White, LE Jr. Pain relief by frontal cingulotomy. J Neurosurg. 1962;19:89–94.CrossRefGoogle Scholar
8.Knight, GC. The orbital cortex as an objective in the surgical treatment of mental illness. The development of the stereotactic approach. Br J Surgery. 1964;51:114–124.CrossRefGoogle ScholarPubMed
9.Herner, T. Treatment of mental disorders with frontal stereotactic thermal lesions. A follow-up study of 116 cases. Acta Psychiatrica Neurolog Scand. 1961;158:36.Google Scholar
10.Kelly, D, Richardson, A, Mitchell-Heggs, N. Technique and assessment of limbic leucotomy, In: Laitinen, LV, Livingston, KE, eds. Surgical Approaches in Psychiatry. Baltimore, Md: University Park Press; 1973:165–173.Google Scholar
11. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Report and Recommendations: Psychosurgery. Department of Health and Human Services. Pub No (OS) 77-002. Washington DC: US Government Printing Office; 1979.Google Scholar
12.Vasko, T, Kullberg, G. Results of psychological testing of cognitive functions in patients undergoing stereotactic psychiatric surgery. In: Hitchcock, ER, ed. Modern Concepts in Psychiatric Surgery. Amsterdam: Elsevier Biomedical Press; 1979:303.Google Scholar
13.Corkin, S, Twitchell, TE, Sullivan, EV. Safety and efficacy of cingulotomy for pain and psychiatric disorders. In: Hitchcock, ER, Ballantine, HT, Myerson, BA, eds. Modern Concepts in Psychiatric Surgery. Amsterdam: Elsevier; 1979:253–272.Google Scholar
14.Spangler, WJ, Cosgrove, GR, et al.Magnetic resonance image-guided stereotactic cingulotomy for intractable psychiatric disease. Neurosurgery. 1996;38:1071.CrossRefGoogle ScholarPubMed
15.Hodgkiss, AD, Malizia, AL, Bartlett, JR, et al.Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy, 1979-1991. J Neuropsychiatry. 1995;7:230.Google ScholarPubMed
16.Poyton, AM, Kartsounis, LD, Bridges, PK. A prospective clinical study of stereotactic subcaudate tractotomy. Psychological Med. 1995;25:763–770.CrossRefGoogle Scholar
17.Mindus, P, Rasmussen, SA, Lindquist, C. Neurosurgical treatment for refractory obsessive-compulsive disorder: implications for understanding frontal lobe function. J Neuropsychiatry. 1994;6(4):467–477.Google ScholarPubMed
18.Papez, JW. A proposed mechanism of emotion. Arch Neurol Psychiatry. 1937;38:725–743.CrossRefGoogle Scholar
19.McLean, PD. Some psychiatric implications of physiologic studies on the frontotemporal portion of limbic system. Electroenceph Clin Neurophysiol. 1952;4:407–418.CrossRefGoogle Scholar
20.Laitinen, LV. Emotional responses to subcortical electrical stimulation in psychiatric patients. Clin Neurol Neurosurg. 1979;81:148–157.CrossRefGoogle ScholarPubMed
21.Talairach, J, Bancaud, J, Geier, S. The cingulate gyrus and human behaviour. Electroencephalogr Clin Neurophysiol. 1973;34:45–52.CrossRefGoogle ScholarPubMed
22.Hutchison, WD, Davis, KD, Lozano, AM, et al.Pain-related neurons in the human cingulate cortex. Nat Neurosci. 1999;2(5):403–405.CrossRefGoogle ScholarPubMed
23.Hess, WR. Diencephalon: Autonomic and Extrapyramidal Functions. New York, NY: Grune & Stratton; 1954.Google Scholar
24.Weilburg, JB, Mesulam, MM, Weintraub, S, et al.Focal striatal abnormalities in a patient with obsessive compulsive disorder. Arch Neurol. 1989;46:233–236.CrossRefGoogle Scholar
25.Luxenberg, JS, Swedo, SE, Flament, MF, et al.Neuroanatomical abnormalities in obsessive compulsive disorder detected with a quantitative x-ray computed t tomography. Am J Psychiatry. 1988;145:1089–1093.Google Scholar
26.Mayberg, HS, Brannon, HK, Mahurin, RK, et al.Cingulate function in depression: a potential predictor of treatment response. Neuroreport. 1997;8:1057–1061.CrossRefGoogle ScholarPubMed
27.Bonne, O, Krausz, Y, Bocher, M, et al.Increased cerebral blood flow in depressed patients responding to electroconvulsive therapy. J Nucl Med. 1996;37:1075–1080.Google ScholarPubMed
28.Rauch, SL, Jenike, MA, Alpert, NM, et al.Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using 15-O-labelled CO2 and positron emission tomography. Arch Gen Psychiatry. 1994;51:62–70.CrossRefGoogle Scholar
29.Baxter, LR, Schwartz, JM, Phelps, ME, et al.Reduction of prefrontal glucose metabolism common to three types of depression. Arch Gen Psychiatry. 1989;46:243–250.CrossRefGoogle ScholarPubMed
30.Baxter, LR Jr, Schwartz, JM, Bergman, KS, et al.Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive compulsive disorder. Arch Gen Psychiatry. 1992;49:681–689.CrossRefGoogle ScholarPubMed
31.Stagno, SJ, Smith, ML, Hassenbusch, SJ. Reconsidering “psychosurgery” issues of informed consent and physician responsibility. J Clin Ethics. 1994;5:217–223.CrossRefGoogle ScholarPubMed
32.Ballantine, HT, Giriunas, IE. Treatment of intractable psychiatric illness and chronic pain by stereotactic cingulotomy. In: Schmidek, HH and Sweet, WH, eds. Operative Neurosurgical Techniques. New York, NY: Grune & Stratton; 1982:1069–1075.Google Scholar
33.Ballantine, HT, Bouckoms, AJ, Thomas, EK, et al.Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry. 1987;22:807–819.CrossRefGoogle ScholarPubMed
34.Mitchell-Heggs, N, Kelly, D, Richardson, A, McLeigh, J. Further exploration of limbic leucotomy. In: Hitchcock, ER, Ballantine, HT Jr., Meyerson, BA, eds. Modern Concepts in Psychosurgery. Amsterdam: Elsevier/North-Holland Biomedical Press; 1979.Google Scholar
35.Talairach, J, Hecaen, H, David, M. Lobotomie prefrontale limitee par electrocoagulation des fibres thalamofrontalis leur emergence du bras anterior de la capsule interne. Proceedings of the 4th Congress Neurologique Internationale. Paris: Masson; 1949: 141.Google Scholar
36.Leksell, L. A stereotaxic apparatus for intracerebral surgery. Acta Chir Scand. 1949;99:229–233.Google Scholar
37.Cosgrove, GR, Rauch, SL. Psychosurgery. In: Gildenberg, PH, ed. Functional Neurosurgery. Philadelphia, Pa: W. B. Saunders Co; 1995.Google Scholar