Resurgence of Psychosurgery: Modern Neurosurgery for Mental Disorders
Chottiwat Tansirisithikul MD*, Bunpot Sitthinamsuwan MD, MSc*
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : A significant percentage of psychiatric patients fail all treatment modalities including drugs, psychotherapy and
electroconvulsive therapy. Modern psychosurgery is a viable option in these patients. Also the history of psychosurgery is
very interesting and still influencing public perception nowadays.
Objective : The surgery aim to improve disabling symptoms of patients with minimal complications.
Material and Method: Medical literatures were reviewed by the authors regarding history, surgical procedures and results.
Results : Once almost extinct, psychosurgery now becomes more important therapeutic role for treatment of psychiatric
diseases. Improved neurosurgical techniques led to significant drop in morbidity and mortality. Although not perfect, better
understanding of pathophysiology also led to more precise target for therapy with hopefully more efficacy. Recently, there is
trend toward reversible neuromodulation instead of ablative procedures. For psychiatric diseases, such as obsessive
compulsive disease and major depressive disorder, substantial numbers of patients fail combination of standard treatments:
drugs, psychotherapy and electroconvulsive therapy which have grave prognosis. The need for effective therapy and advanced
in knowledge in this field will lead to expanded use of psychosurgery in the near future.
Conclusion : History of psychosurgery is reviewed. Principle of pathophysiology, patient selection processes and perioperative
management are described. Surgical procedures both ablative surgery and neuromodulation are demonstrated as well.
Keywords : psychosurgery, psychiatric disorder, stereotactic surgery
