Neurosurgery for Psychiatric Disorders: Obsessive-Compulsive Disorder

Abstract

In 1949 E. Moniz received the Nobel Award for the development of frontal leucotomy. Surgical interruption of a major part of fronto-thalamic connections had a clear and often beneficial sedating effect in patients suffering from severe psychosis but irreversible side-effects, namely emotional blunting, had been frequent. Growing public criticism for misuse in improperly selected patients as well as the development of neuroleptics made this treatment obsolete in the late 50s. In the 60s stereotactic techniques became more and more refined, enabling precise lesioning of small volumes of brain tissue. Stereotactic cingulotomy, fronto-basal-tractotomy and anterior capsulotomy had become the most frequently used stereotactic procedures to treat anxiety-disorders and obsessive-compulsive disorders. Although amenable results could be achieved in these often devastating conditions, there remained the fact, that thermo-, like cryoablations, are irreversible procedures which may lead to persistent side-effects. This and the historically bad connotation of psychosurgery in general, had been the reasons why stereotactic psychosurgical procedures had been used but exceptionally and in very limited numbers.