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Psychosurgery: Stereotactic Subcaudate Tractotomy

An Indispensable Treatment

Published online by Cambridge University Press:  02 January 2018

P. K. Bridges ,
J. R. Bartlett ,
A. S. Hale ,
A. M. Poynton ,
A. L. Malizia  and
A. D. Hodgkiss
P. K. Bridges*
Affiliation:
UMDS, Guy's Hospital and Geoffrey Knight Unit, London
J. R. Bartlett
Affiliation:
SE Thames Regional Neurosurgical Centre and Geoffrey Knight Unit
A. S. Hale
Affiliation:
UMDS, St Thomas's Hospital, London
A. M. Poynton
Affiliation:
UMDS, Guy's Hospital, London SE1 9RT
A. L. Malizia
Affiliation:
UMDS, Guy's Hospital, London SE1 9RT
A. D. Hodgkiss
Affiliation:
UMDS, Guy's Hospital, London SE1 9RT
*
Dr P. K. Bridges, The Geoffrey Knight National Unit for Affective Disorders, Brook General Hospital, Shooters Hill Road, Woolwich, London SE18 4LW
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Abstract

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 reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.

Method

Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.

Results

ST allows 40–60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% postoperatively, from 15% in cases of uncontrolled affective disorders is seen.

Conclusion

As a treatment of last resort, 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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 5 , November 1994 , pp. 599 - 611
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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