Lobotomy Research Articles

Preliminary observation on clinical outcome and safety of surgery in early infants (

ObjectiveTo investigate the clinical outcomes and safety of surgery in infants (< 12 months of age) with drug-resistant epilepsy, clarify surgical indications, and select appropriate surgical methods. MethodsThis was a retrospective analysis of infants with drug-resistant epilepsy who underwent epilepsy surgery and were followed up for > 6 months at the Epilepsy Center of Shenzhen Children's Hospital. Clinical data included etiology, seizure type, surgical procedure, preoperative auxiliary examinations, pathological findings, and intraoperative and postoperative complications. Clinical outcomes were assessed based on postoperative seizure frequency, antiseizure medicines (ASMs) use, and neurocognitive development. Intraoperative blood loss, operative duration, postoperative complications, and duration of intensive care were evaluated to assess the safety of epilepsy surgery. Univariate and logistic analyses were performed to explore the factors influencing prognosis. ResultsEpilepsy surgery was performed on 44 infants with drug-resistant epilepsy, including 7 patients who underwent two operations. The age of seizure onset ranged from 1 day to 11 months (median: 1 month, interquartile range (IQR): 0.1–3.8), the disease course was 1–11 months (median: 4 months, IQR: 2–7), and the age at surgery was 6.9±3.6 months. Twenty-three patients underwent hemispherectomy (52.3%), and two underwent subtotal hemispherectomy. Five patients underwent multilobar disconnection, five underwent frontal lobotomy, and the remaining nine underwent focal resection. The surgical duration was 7.5±2 hours. Intraoperative blood loss ranged from 50–1800 ml (median: 275 ml, IQR: 200–500), with all patients receiving an intraoperative blood transfusion of 0.5–6 U (median: 1.5 U, IQR: 1.5–3). The intensive care unit stay was 1–4 days (median: 1 day, IQR: 1–2). The postoperative complication rate was 13.6% (6/44; two cases of hydrocephalus with intracranial infection, two isolated hydrocephalus, and two subdural hematomas). Excluding one child who died of severe lung infection approximately one year after surgery and one child lost to follow-up after surgery, all other cases were regularly followed up for 10 –49 months (median: 30 months, IQR: 16.5–36). After surgery, patients were treated with 0–3 ASMs (median: 1 ASM, IQR: 0–2); 27.9% (12/43) stopped taking ASMs and 51.2% (22/43) had reduced number of ASMs. Engel I was achieved in 76.7% (33/43) of the patients at the last follow-up. In 17 cases with complete developmental quotient follow-up data, the preoperative and postoperative developmental quotient means were 28.8±21 and 43.2±20.1, showing statistically significant differences (p<0.05) SignificanceEpilepsy surgery in infants under 12 months of age is safe and effective. Early preoperative evaluation is crucial for identifying structural lesions and suitable candidates for surgery among infants with drug-resistant epilepsy. The timeliness of surgery is essential for achieving favorable clinical outcomes.

Neurosurgery as an opportunity to correct symptoms of mental and behavioural disorders

Neurosurgical treatment for psychiatric disorders has a controversial history. This branch of neurosurgery called by developer of prefrontal leucotomy and Nobel prize laureate Egaz Moniz “psychosurgery”, was initially based not on scientific researches, but on enthusiasm of individuals and pressing social need. The outcome of psychosurgery regardless of its clinical benefits was the negative attitude of the broad masses and medical community, some countries have banned psychosurgery – the era of psychopharmacology has come. However, some patients suffering from severe course of the psychiatric disorder are resistant to conservative treatment.Over the last decades, the novel neuroimaging methods and neurobiological researches have considerably improved understanding of the pathogenesis of psychiatric disorders and scientific validity of the surgical intervention into the neural circuits. In this article, the main stages of the history of the psychiatric neurosurgery are briefly reviewed. Furthermore, the clinical and surgical considerations including the anatomic target localization, outcome and possible complications of the major operations which are still in practice are presented. The new neurosurgical techniques such as deep brain stimulation and gamma knife stereotactic radiosurgery were also considered. The part of the article is devoted to ethical, legal and terminological issues of psychiatric neurosurgery.

Spinning lobotomy: A conventional content analysis of articles by the pioneers of the procedure in the United States

Frontal lobotomy, one of the most controversial procedures of the modern era, was pioneered and promoted by Walter J. Freeman and James W. Watts in the United States. The purpose of this study is to analyze the role of bias and spin in their most impactful medical articles on lobotomy. A summative qualitative content analysis of their articles written between 1944 and 1971 reveals that, despite the lack of endorsement by the U.S. medical establishment, Freeman and Watts gave an overwhelmingly positive depiction of lobotomy along prevailing social, economic, and behavioral norms and needs. These results indicate evidence of both confirmation and social desirability bias by the authors.

A comparative history of psychosurgery.

The term "psychosurgery" reflecting neurosurgical treatment of mental disorders, was coined by a Portuguese neurologist Egas Moniz (1874-1955), who, in 1935, suggested a procedure named prefrontal leucotomy (or lobotomy) aimed to divide white matter tracts connecting prefrontal cortex and thalamus. Starting from 1936, this technique and its subsequent modification (transorbital lobotomy) was zealously promoted by a neurologist Walter Freeman (1895-1972) and a neurosurgeon James Watts (1904-1994) at George Washington University, who in 1942 summarized their experience in a monograph, which publication resulted in a tremendous worldwide interest in psychosurgical interventions. The present review describes comparative development of prefrontal leucotomy followed by stereotactic ablation and neurostimulation in three different geographical regions: USA, USSR/Russia, and Far East (China and Japan), where psychosurgery followed nearly similar courses, progressing from the initial enthusiasm and high clinical caseloads to nearly complete disregard. The opposition to neurosurgical interventions for mental disorders around the world was led by different groups and for varying reasons, but, unfortunately, always with political considerations mixed in. Today, with vast advancements in neuroimaging, stereotactic neurosurgical techniques, and physiological knowledge, psychiatric neurosurgery can be performed with much greater precision and safety.

Second-Hand Risk Health Tragedies and Human Right Violations due to Ethanol Consumption. Biochemical basis for metabolic and behavioral Tragedies due to Ethanol Consumption

Everywhere a nonsmoker who is an alcohol consumer, complains of secondhand smoke, without being aware of second-hand risk health tragedies and human rights violations provoked by alcohol consumption. Here we analyze the concept, mainly unexplored, of dramatic adverse health effects and of human rights violations against third parties generated for alcohol consumption by others; and also, the harm due to the chemical transient prefrontal lobotomy generated by alcohol consumption. Alcohol consumption has been a part of the everyday human diet for centuries, especially because of the fact that alcoholic beverages are a safe means of hydration wherever clear water has not been available [1]. Old patients could, simultaneously be part of the alcohol consumers and/or secondhand victims. Before deciding to analyze the geriatric problems, we propose the allegorical model, based on Scott, Ellison, and Sinclair, as it was published in Nature Aging, in July 2021. We divide the theoretical analysis with four fundamental alternatives [2]: The extension of life (Struldbrug case). In Jonathan Swift's 1726 novel “Gulliver's Travels”, the struldbrugs were humans born apparently normal. The Struldbruggs, however immortal however they age normally, live in continuously deteriorating health. This takes us to the philosophical alternative of: “living or lasting” [2]. To lower morbidity (Dorian Gray case). Narratively, in “The Picture of Dorian Gray” a philosophical novel by Oscar Wilde, Dorian Gray owns a portrait of himself and while the picture ages, Dorian Gray does not change, maintaining his health and appearance until death [2]. Slowing aging (Peter Pan case), In this extreme case, where aging is not just slowed but canceled, the mortality and the health become independent of the age, and thus the individual is ‘forever young’. This constitutes the ‘Peter Pan’ case, after the play and novel about a boy who never grows old. This closely corresponds to the Hypocaloric diet claiming that it slows aging [2]. To reverse aging physical damage is repaired instead of slowed. This is a close analogy to the “Theseus Boat” as well as the regeneration of salamanders and lizards and transplants from donors. Desiderative, this is the future of organoids and the engineering of the pluripotent cell [2].

La première intervention de lobotomie documentée en France. 2 décembre 1939–Docteur Gaston Ferdière

In January 1940, the first bulletin of the year of the journal «Annales Médico-Psychologiques» (Ann. Med.-Psych., 15th series, 98th year, T.I, January 1940, 522 p.) [11], published the report of the session of December 2, 1939 of the Société Médico-Psychologique, and in particular a communication by Doctor Gaston Ferdière, on a case of lobotomy (immediate results of prefrontal leucotomy in a case of catatonic stupor, pp 111-119), intervention performed at the hospital of Issoudun (Sub-prefecture of the department of Indre; 36) on December 2, 1939, and also reports the lively discussion that followed, with, in particular, the criticisms of Professor Henri Baruk. This is the first communication relating to the use of this technique in France, and if today its scientific and therapeutic interest is only historical, this method of leucotomy, however considered at the time as innovative, having been deleted, these paper poses ethical questions that remain very topical. After having summarized the communication and the discussion, and described, for the record, the method, we will evoke these questions, then the author's life of the paper: Doctor Gaston Ferdière, who remains known for having been the psychiatrist of Antonin Artaud, and whose professional career, and the image he left, paradoxical, are in themselves a true ethical tragedy.

The Future of Training and Practice in Neuromodulation: An Interventional Psychiatry Perspective.

Psychiatrists have been proceduralists dating back almost 100 years, nearly to psychiatry's inception as a medical specialty. Electroconvulsive therapy (ECT) was developed as a procedure in the 1930s and refined over time, with impressive efficacy and response rates (1). However, due to a lack of understanding of the pathophysiology of many psychiatric conditions, combined with disastrous outcomes from premature adoption of other procedural treatments such as transorbital lobotomy (2), procedural options for psychiatric treatment have been limited. In recent years this landscape is changing, again introducing the potential for procedural therapies in neuropsychiatric disease management. The subspecialty focused on procedure-based psychiatric care, specifically utilization of neurotechnologies to treat psychiatric disorders has become known as “interventional psychiatry.” Interventional psychiatry frequently employs treatments under the umbrella of “psychiatric neuromodulation,” which we define as the collection of nervous system stimulation therapies focused on modulating dysfunctional brain circuitry for therapeutic benefit, including use of electrical, magnetic, ultrasonic, and photic stimulation (see Table 1 for examples). As practically applied, interventional psychiatry also often incorporates procedure-based pharmacologic interventions such as ketamine infusion therapy and psychedelic therapies, which similarly involve a medical intervention applied to a treatment-refractory patient population and require familiarity with procedural consent and monitoring. Here we outline the state of the field, as well as implications for training and the role of the interventional psychiatrist in the treatment team. Table 1 Proposed competency areas for trans-disciplinary fellowship in interventional psychiatry or psychiatric neuromodulation.

The Proud History of Psychosurgery in the USA.

To understand the development and growth of psychosurgery, the context of psychiatric care in the mid-twentieth-century USA must be considered-for example, overpopulation and understaffing of public institutions, and typical use of psychotherapy, which was generally useless in treating the symptomatology of severe mental illness. Therefore, the introduction of prefrontal lobotomy (and, later, transorbital lobotomy) by Drs.Walter Freeman and James Watts, who modified the technique of leukotomy developed by Nobel Prize laureate Dr.Egas Moniz, was considered revolutionary and quickly gained widespread acceptance by medical community. No other alternative treatment at the time demonstrated comparable efficacy. At its peak, psychosurgery was sometimes applied inappropriately, but records from multiple institutions across the USA demonstrate that these were exceptional cases, whereas, as a rule, selection of surgical candidates was based on very strict criteria, indicating the high professionalism and humanity of medical staff. Although psychosurgery has declined heavily since the 1950s, it is not obsolete and is currently considered a valuable treatment option, realized through various open, stereotactic, or radiosurgical procedures.

Psychosurgery: A History from Prefrontal Lobotomy to Deep Brain Stimulation

Neurosurgical treatment for psychiatric disorders features a long and controversial history. This article explores a ‘spectrum of psychosurgery,’ describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day, mainstream scientific deep brain stimulation (DBS). We focus on the rise, fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy, which evoked stern criticism from both public and professionals, through to the development of modern day DBS - performed for patients suffering from severe, treatment resistant symptoms of obsessive-compulsive disorder (OCD), epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities, whilst simultaneously challenging any public/professional preconceptions of psychosurgery, which may indirectly be obstructing patient care.Additionally, we carried out a qualitative survey displayed in WordCloud Format, capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust, on ‘psychosurgery,’ ‘prefrontal lobotomy’ and ‘DBS’, which may well reflect wider public opinion.In summary, the article provides a brief, yet comprehensive overview of the controversial history of psychosurgery, present-day practice, and future trends of neurosurgery for psychiatric disorders.

Postcentral Topectomy for Pain Relief: A Historical Review and Possible Improvements

Postcentral topectomy is a neurosurgical procedure, practiced in the mid-20th century, in which surgical ablations of the primary somatosensory cortex were used as a therapeutic means of treating patients suffering from intractable chronic pain. While successful in curing some—but not all—patients, the procedure was poorly understood and eventually became displaced by methods that more consistently stopped patient complaints of pain, such as opiates and frontal lobotomies. However, a more recent discovery of a nociresponsive region in the transitional zone between the primary somatosensory cortex and the primary motor cortex (lying in Brodmann Area 3a anterior to its better known proprioceptive region) raises the possibility that the outcome of postcentral topectomy depended in each patient on whether the ablation extended deep enough into the central sulcus to remove this cortical region. Here we review every postcentral topectomy case we could find in the neurosurgical literature in order to evaluate its past effectiveness and to reassess its potential in light of modern knowledge of the cerebral cortex. We found 17 full-text reports from 16 different surgical teams describing outcomes of the procedure in 27 patients. Among those, in only 5 patients the procedure either failed to abolish the targeted chronic pain or the pain returned to its preoperational levels several weeks or months after the surgery. In the other 22 patients, their pain stayed abolished or at least significantly reduced as of the last evaluation by the treating physician (which was one year or more for 9 patients). We propose that the probability of a successful outcome might be brought to near 100% by selective targeting—guided by functional imaging—of the nociresponsive region in Area 3a.

Kurt Goldstein’s critique of Leo Kanner: understanding autism as an impairment of the abstract attitude

ABSTRACT The author argues for a functionalist understanding of autism. Instead of explaining autism as an inborn or otherwise neurological deficit, autism may be understood as a functional disturbance: the impairment of the abstract attitude. The abstract attitude is a concept developed by German neuropsychiatrist Kurt Goldstein (1987–1965) to describe severe behavioural disturbances in brain-injury, frontal lobotomy, and psychosis (Goldstein, K., & Scheerer, M. (1941). and concrete behaviour: An experimental study with special tests. Psychological Monographs, 53(2), 1–151). The abstract attitude involves volition, will, and perspective, and is necessary for humans to understand and communicate through language or make judgements and evaluations. One finds in the abstract attitude an important aspect of being human (Goldstein, K. (1959). Abnormal mental conditions in infancy. Journal of Nervous and Mental Diseases, 128(6), 538–557). Contemporary research that supports Goldstein's thesis is presented, as well as the promise of child-centered play therapy for autism treatment.

Does DBS Have a Future in Depression Treatment?

Does DBS Have a Future in Depression Treatment?

Tau progression in single severe frontal traumatic brain injury in human brains

The neuropathological features of chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury (TBI), include abnormal accumulations of hyper-phosphorylated tau (p-tau) protein in neurons, neurites and astrocytes, considered to progress via neuronal circuits in brains. Some previous reports suggest that a single severe TBI (sTBI) can also induce CTE and p-tau accumulation, but it is not clear whether the pathology is the same as that of repetitive TBI (rTBI). Since prefrontal leucotomy could be regarded as a model of sTBI, in this study we evaluated two autopsied schizophrenia with this procedure. Histopathologically, gliosis and neuronal loss were found not only in the primary ablated prefrontal region, but also in secondary affected areas, i.e., cingulate gyrus, medial nucleus of the thalamus, and nucleus accumbens, which are connected to prefrontal areas. Accumulation of p-tau was mostly seen in neurons, neurites and glias around small blood vessels in the leucotomized prefrontal region. In addition, secondary regions showed some p-tau-positive neurons/glias, as well as many axonal spheroids. Regions of neuronal/glial p-tau pathology showed immunoreactivity to both 3R/4R tau antibodies. Immunoblot analyses of sarkosyl-insoluble tau from frozen brains showed an AD-type tau banding pattern with strong immunoreactivities. sTBI patients showed limited comorbidities, such as TDP-43, alpha-synuclein or AD pathology, whereas rTBI patients have high frequencies of them. The findings suggest that p-tau in the primary affected lesion might progress to connected regions via neuronal circuits over time, and a single severe axonal injury might lead to CTE pathology different from that caused by rTBI.

Jean Talairach: a cerebral cartographer.

Although French psychiatrist-turned-neurosurgeon Jean Talairach (1911-2007) is perhaps best known for the stereotaxic atlas he produced with Pierre Tournoux and Gábor Szikla, he has left his mark on most aspects of modern stereotactic and functional neurosurgery. In the field of psychosurgery, he expressed critique of the practice of prefrontal lobotomy and subsequently was the first to describe the more selective approach using stereotactic bilateral anterior capsulotomy. Turning his attention to stereotaxy, Talairach spearheaded the team at Hôpital Sainte-Anne in the construction of novel stereotaxic apparatus. Cadaveric investigation using these tools and methods resulted in the first human stereotaxic atlas where the use of the anterior and posterior commissures as intracranial reference points was established. This work revolutionized the approach to cerebral localization as well as leading to the development of numerous novel stereotactic interventions by the Sainte-Anne team, including tumor biopsy, interstitial irradiation, thermal ablation, and endonasal procedures. Together with epileptologist Jean Bancaud, Talairach invented the field of stereo-electroencephalography and developed a robust scientific methodology for the assessment and treatment of epilepsy. In this article the authors review Talairach's career trajectory in its historical context and in view of its impact on modern stereotactic and functional neurosurgery.

The prodigious and tumultuous life of Hamilton Bailey, surgeon, author, and teacher.

Hamilton Bailey was a British Surgeon, a prolific writer and a gifted teacher. He published 15 books, including, "Demonstrations of Physical Signs in Clinical Surgery, two volumes of Emergency Surgery and the Short Practice of Surgery (Bailey and Love). They were illustrated profusely with help of his wife Veta, went to multiple editions, multiple languages and are still in print today! He had a tall, striking physique, a shy personality (mistaken for domineering) and no social skills. He never could secure a teaching position in a London Medical School. The tragic death of his son in an accident in 1943 forced him to bury himself in hectic schedule of operating and re-editing his books. With a family history of psychiatric illness, his mental status deteriorated and he was "incarcerated" in a mental institution for three years. On the cusp of a pre-frontal lobotomy, he recovered with Lithium treatment well enough to settle down in Spain and continue his books. His death in 1961 of colon obstruction was a result of his own difficult behavior as a patient and his denial of a decompressive colostomy, contrary to his own teachings. His legacy lives on in a trust he and his wife Veta set up to support medical education in third world countries.

Engaños en el percibir afectivo del dolor

Este artículo estudia las variaciones del “percibir afectivo” (Fühlen) del dolor, al que denominamos “dolorsentimiento” por ofrecernos la “cara valorativa” del “dolor-sensación”. En él consideramos el percibir afectivo del dolor como un acto cognoscitivo, de modo que sus variaciones constituyen estrictos “engaños (Täuschungen) afectivos”, que, a nivel formal, podrían ir desde el sufrir por exceso hasta la indiferencia o el disfrute. Pero el artículo defiende que, en realidad, los únicos engaños que se producen de hecho son engaños por exceso, en los que el dolor se sufre más de lo debido (engaños ligados al hedonismo). Y el disfrute del dolor o la indiferencia, que se dan respectivamente en el masoquismo y en las leucotomías prefrontales, se sitúan ya en el ámbito de las “respuestas afectivas” al dolor, que en el artículo se distinguen con claridad del nivel previo del percibir afectivo. A su vez, las variaciones del percibir afectivo se diferencian de las variaciones del “umbral del dolor-sensación”, estudiadas desde la psicofísica.

Evolution in the Treatment of Psychiatric Disorders: From Psychosurgery to Psychopharmacology to Neuromodulation.

The treatment of psychiatric patients presents significant challenges to the clinical community, and a multidisciplinary approach to diagnosis and management is essential to facilitate optimal care. In particular, the neurosurgical treatment of psychiatric disorders, or “psychosurgery,” has held fascination throughout human history as a potential method of influencing behavior and consciousness. Early evidence of such procedures can be traced to prehistory, and interest flourished in the nineteenth and early twentieth century with greater insight into cerebral functional and anatomic localization. However, any discussion of psychosurgery invariably invokes controversy, as the widespread and indiscriminate use of the transorbital lobotomy in the mid-twentieth century resulted in profound ethical ramifications that persist to this day. The concurrent development of effective psychopharmacological treatments virtually eliminated the need and desire for psychosurgical procedures, and accordingly the research and practice of psychosurgery was dormant, but not forgotten. There has been a recent resurgence of interest for non-ablative therapies, due in part to modern advances in functional and structural neuroimaging and neuromodulation technology. In particular, deep brain stimulation is a promising treatment paradigm with the potential to modulate abnormal pathways and networks implicated in psychiatric disease states. Although there is enthusiasm regarding these recent advancements, it is important to reflect on the scientific, social, and ethical considerations of this controversial field.

History of lobotomy in Poland.

In Poland, there were 176 cases of prefrontal leucotomy performed by Moniz's method between 1947 and 1951. There were also several cases in which alternative psychosurgical techniques were used: prefrontal topectomy by Bilikiewicz and colleagues, and prefrontal topischemia by Ziemnowicz. This article analyses the following: publications by Choróbski, who performed lobotomy in Poland, and by Korzeniowski, who assessed its short-term results; a report by Bornsztajn, who reviewed general results of the method; and clinical research by Broszkiewicz and by Konieczyńska, who assessed Polish patients in terms of long-term results of lobotomy. Negative clinical evaluation of lobotomy led to its abandonment in Poland, a decision strengthened by a regulation that forbade lobotomy in the USSR and impacted Polish psychiatry.

Egas Moniz: 90 Years (1927-2017) from Cerebral Angiography.

In June 2017 we celebrate the 90th anniversary of the pioneer discovery of cerebral angiography, the seminal imaging technique used for visualizing cerebral blood vessels and vascular alterations as well as other intracranial disorders. Egas Moniz (1874–1955) was the first to describe the use of this revolutionary technique which, until 1975 (when computed tomography, CT, scan was introduced in the clinical practice), was the sole diagnostic tool to provide an imaging of cerebral vessels and therefore alterations due to intracranial pathology. Moniz introduced in the clinical practice this fundamental and important diagnostic tool. The present contribution wishes to pay a tribute to the Portuguese neurosurgeon, who was also a distinguished neurologist and statesman. Despite his tremendous contribution in modern brain imaging, Egas Moniz was awarded the Nobel Prize in Physiology or Medicine in 1949 for prefrontal leucotomy, the neurosurgical intervention nowadays unacceptable, but should rather be remembered for his key contribution to modern brain imaging.

The origins and persistence of psychosurgery in the state of Iowa.

Neurosurgery for the treatment of psychological disorders has a checkered history in the United States. Prior to the advent of antipsychotic medications, individuals with severe mental illness were institutionalized and subjected to extreme therapies in an attempt to palliate their symptoms. Psychiatrist Walter Freeman first introduced psychosurgery, in the form of frontal lobotomy, as an intervention that could offer some hope to those patients in whom all other treatments had failed. Since that time, however, the use of psychosurgery in the United States has waxed and waned significantly, though literature describing its use is relatively sparse. In an effort to contribute to a better understanding of the evolution of psychosurgery, the authors describe the history of psychosurgery in the state of Iowa and particularly at the University of Iowa Department of Neurosurgery. An interesting aspect of psychosurgery at the University of Iowa is that these procedures have been nearly continuously active since Freeman introduced the lobotomy in the 1930s. Frontal lobotomies and transorbital leukotomies were performed by physicians in the state mental health institutions as well as by neurosurgeons at the University of Iowa Hospitals and Clinics (formerly known as the State University of Iowa Hospital). Though the early technique of frontal lobotomy quickly fell out of favor, the use of neurosurgery to treat select cases of intractable mental illness persisted as a collaborative treatment effort between psychiatrists and neurosurgeons at Iowa. Frontal lobotomies gave way to more targeted lesions such as anterior cingulotomies and to neuromodulation through deep brain stimulation. As knowledge of brain circuits and the pathophysiology underlying mental illness continues to grow, surgical intervention for psychiatric pathologies is likely to persist as a viable treatment option for select patients at the University of Iowa and in the larger medical community.