Abstract
In the wake of deep brain stimulation (DBS) development, ablative neurosurgical procedures are seeing a comeback, although they had been discredited and nearly completely abandoned in the 1970s because of their unethical practice. Modern stereotactic ablative procedures as thermal or radiofrequency ablation, and particularly radiosurgery (e.g., Gamma Knife) are much safer than the historical procedures, so that a re-evaluation of this technique is required. The different approaches of modern psychiatric neurosurgery refer to different paradigms: microsurgical ablative procedures is based on the paradigm ‘quick fix,’ radiosurgery on the paradigm ‘minimal-invasiveness,’ and DBS on the paradigm ‘adjustability.’ From a mere medical perspective, none of the procedures is absolutely superior; rather, they have different profiles of advantages and disadvantages. Therefore, individual factors are crucial in decision-making, particularly the patients’ social situation, individual preferences, and individual attitudes. The different approaches are not only rivals, but also enriching mutually. DBS is preferable for exploring new targets, which may become candidates for ablative microsurgery or radiosurgery.
Highlights
Since 2000, there is a renaissance of neurosurgical treatments of psychiatric disorders
About 90% of functional neurosurgeons feel optimistic about the future of psychiatric neurosurgery (Lipsman et al, 2011; Mendelsohn et al, 2013)
The different approaches of modern psychiatric neurosurgery refer to different paradigms: microsurgical ablative procedures is based on the paradigm ‘quick fix,’ radiosurgery on the paradigm ‘minimal-invasiveness,’ and deep brain stimulation (DBS) on the paradigm ‘adjustability.’
Summary
Since 2000, there is a renaissance of neurosurgical treatments of psychiatric disorders. Many researchers and clinicians hope that modern neurosurgical approaches will be established as treatment options for a growing number of therapy-refractory psychiatric disorders. Modern psychiatric neurosurgery includes DBS and ablative neurosurgical procedures (thermal or radiofrequency ablation, and radiosurgery). It is not justified to characterize modern lesioning procedures as successors of historical psychosurgery, while presenting DBS as something quite different. Both psychiatric DBS and modern ablative psychiatric neurosurgery are significantly improved successors of the historical psychosurgery
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