Psychosurgery: stereotactic subcaudate tractomy. An indispensable treatment.
BACKGROUND
Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.


METHODS
Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.


RESULTS
SST allows 40-60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% post-operatively, from 15% in cases of uncontrolled affective disorders is seen.


CONCLUSIONS
As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.
Bridges
P K
PK
UMDS, Guy's Hospital, London.
Bartlett
J R
JR
Hale
A S
AS
Poynton
A M
AM
Malizia
A L
AL
Hodgkiss
A D
AD
D000328:Adult; D000368:Aged; D001931:Brain Mapping; D002421:Caudate Nucleus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D008875:Middle Aged; D010380:Peer Review; D011612:Psychosurgery / Q000379:methods*; D013238:Stereotaxic Techniques; D016896:Treatment Outcome