A Brief History of Neurosurgery for Mental Disorder

Psychosurgery under the spotlight

The first major review of neurosurgery was carried out by Tooth and Newton in 1961 (Tooth & Newton, 1961). They reviewed over 10,000 procedures that were carried out between 1942 and 1954. Forty percent had been unwell for at least six years prior to neurosurgery. Eighty percent had a standard (freehand) leucotomy, and only 9% had one of the more modern (stereotactic) surgical techniques. Two thirds had chronic schizophrenia, and these patients had the worst outcome: only 17-20% of the patients had totally recovered.

A review of neurosurgery for psychological disorders in the UK during the period 1974 – 1976 looked at main indications for surgery (Barraclough & Mitchell-Heggs, 1978). Within the three main centres providing functional neurosurgery (accounting for 58% of the total operations), the primary indication for surgery was:

Depression (63%)
‘Anxiety, tension, and phobic states’ (12%)
Violence (8%)
Obsessive-compulsive disorder (7%)

By 2000, these figures had shifted, and the primary indications for surgery were (Freeman, Crossley & Eccleston, 2000):

Depression (64.7%)
OCD (20.6%)
Bipolar Disorder (11.8%)
Anxiety (2.9%)

Although used for the treatment of aggressive states (Cox & Brown, 1977; Mayangi & Sano, 1979; Schvarcz, 1977), sexual deviation (Dieckmann, Horn & Schneider, 1979), and drug misuse (Balasubramaniam, Kanaka & Ramanujam, 1973) throughout the 1960s and 1970s, today in the Western Hemisphere NMD is not considered a suitable intervention for aggressive, impulsive, antisocial, or hypersexual behaviour. However, it continues to be used for aggression and drug misuse in some parts of the world, including the Far East (Gao, Wang, He, et al, 2003; Kim, Lee & Choi, 2002) and Russia (Medvedev, Anichkov & Polyakov, 2003). As recently as 1996 it was being performed for schizophrenia in Brazil (da Costa, 1997).

Balasubramaniam, V., Kanaka, T. S. & Ramanujam, P. B. (1973) Stereotaxic cingulumotomy for drug addiction. Neurology India, 21, 63-66.
Barraclough, B. M. & Mitchell-Heggs, N. A. (1978) Use of neurosurgery for psychological disorder in British Isles during 1974-6. BMJ, 2, 1591-1593.
Cox, A. W. & Brown, M. H. (1977) Results of Multi-target Limbic Surgery in the Treatment of Schizophrenia and Aggressive States. In Neurosurgical Treatment in Psychiatry, Pain and Epilepsy (eds W. H. Sweet, S. Obrador & J. G. Martin-Rodriguez), pp. 469-479. Baltimore: University Park Press.
da Costa, D. A. (1997) The role of psychosurgery in the treatment of selected cases of refractory schizophrenia: a reappraisal. Schizophrenia Research, 28, 223-230.
Dieckmann, G., Horn, H.-J. & Schneider, H. (1979) Long-term Results of Anterior Hypothalamotomy in Sexual Offences. In Modern Concepts in Psychiatric Surgery (eds E. R. Hitchcock, H. T. Ballantine, Jr & B. A. Meyerson), pp. 187-195. New York: Elsevier/ North Holland Biomedical Press.
Freeman, C., Crossley, D. & Eccleston, D. (2000) Neurosurgery for mental disorder. Report from the Neurosurgery Working Group of the Royal College of Psychiatrists. London: Royal College of Psychiatrists.
Gao, G., Wang, X., He, S., et al (2003) Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Stereotactic and Functional Neurosurgery, 81, 96-104.
Kim, M. C., Lee, T. K. & Choi, C. R. (2002) Review of long-term results of stereotactic psychosurgery. Neurologia Medico-Chirurgica, 42, 365-371.
Mayangi, Y. & Sano, K. (1979) Long-term Follow-up Results of Posteromedial Hypothalamotomy. In Modern Concepts in Psychiatric Surgery (eds E. R. Hitchcock, H. T. Ballantine, Jr & B. A. Meyerson), pp. 197-204. New York: Elsevier/ North Holland Biomedical Press.
Medvedev, S. V., Anichkov, A. D. & Polyakov, Y. I. (2003) Physiological Mechanisms of the Effectiveness of Bilateral Stereotactic Cingulotomy against Strong Psychological Dependence in Drug Addicts. Human Physiology, 29, 492-497.
Schvarcz, J. R. (1977) Results of Stimulation and Destruction of the Posterior Hypothalamus: A Long-term Evaluation. In Neurosurgical Treatment in Psychiatry, Pain and Epilepsy (eds W. H. Sweet, S. Obrador & J. G. Martin-Rodriguez), pp. 429-438. Baltimore: University Park Press.
Tooth, J. C. & Newton, M. P. (1961) Leucotomy in England and Wales 1942-1954. Reports on public health and medical subjects. London: Ministry of Health.