Functional Stereotactic Neurosurgery for Psychiatric Disorders: an Experience in Belgium and The Netherlands

Abstract

This chapter addresses the difficult and often contentious subject of psychosurgery which has been defined as “a neurosurgical intervention to sever fibres connecting one part of the brain with another, or to remove or destroy brain tissue with the intent of modifying or altering severe disturbance of behaviour, thought content or mood”. The authors have traced the historical development of psychosurgery and brought out the fact that it is those patients suffering from anxiety, depression and obsessive compulsive illness who throughout this history of psychosurgery have benefited most. They also refer to the “taming effects” of the old leucotomy (obsolete since the mid-1950’s) which had proved useful in the management of certain behaviour disorders of schizophrenia. This latter effect often left patients with severe blunting of personality, but the operation, judged in the context of the alternatives available at the time was better than nothing for this unfortunate group. It allowed 20% to return to life in the community. However, as the authors emphasize this became history with the discovery in the 1950’s of the major tranquilizers and effective pharmacological agents for the treatment of depression and anxiety which has transformed psychiatry. Nonetheless, some patients remain resistant to the newer treatments and it is this which keeps an interest in psychosurgery alive. The introduction of stereo-tactic techniques, increasingly accurate imaging techniques for target identification and precise lesions have all contributed to a very low morbidity of modern procedures. It is now well recognised that Psychiatrists and Neurosurgeons must work in close partnership to ensure the cases are appropriately selected.

We are pleased to publish the following commentary by Mr. John Bartlett of the Brook Hospital, London, who has Britain’s greatest experience in the management of such cases. The Editors