Abstract
Surgical treatment for psychiatric disorders can be dated back to Neanderthal times. Advancement of surgical treatments has coincided with progressive imaging modalities and understanding of neural networks. From Papez's description of the limbic system to current studies utilizing PET and diffusion tensor MRI, our understanding of neural circuitry has lead to theories of alterations in cortico-striato-thalamo-cortical (CSTC) loops causing psychiatric disorders such as major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Early surgical techniques focused on lesioning structures involved in CSTC loops. These procedures included anterior cingulotomy (ACT), anterior capsulotomy (AC), subcaudate tractotomy (SCT), and sterotactic limbic leucotomy (LL). Deep brain stimulation (DBS) has now been studied in OCD, MDD, Tourette's Syndrome (TS), addiction, aggression, anorexia, and anxiety disorders. Targets for OCD include ventral capsule/ventral striatum (VC/VS), anterior limb of internal capsule (ALIC), Nucleus Accumbens (NA), subthalamic nucleus (STN), and inferior thalamic peduncle (ITP). Targets for MDD include VC/VS, VS/NAc, subgenual cingulate cortex (SCC), and medial forebrain bundle (MFB). Targets for TS include medial thalamus, globus pallidus (GP), ALIC, and STN. The surgical targets with most benefit have not yet been defined and likely are patient dependent. In this chapter we further discuss surgical indications, target selection, ethical considerations, other treatment options, and future directions.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
