Psychosurgery: past, present, and future.
Psychosurgery, the neurosurgical treatment of psychiatric disease, has a history dating back to antiquity, and involves all of the clinical neurosciences. This review discusses the history of psychosurgery, its development in the 19th century, and the conditions of its use and abuse in the 20th century, with a particular focus on the frontal lobotomy. The transition to the modern era of psychosurgery is discussed, as well as the neurobiology underlying current psychosurgical procedures. The techniques of stereotactic cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leukotomy are described, as well their indications and side effects. Due to the past abuse of psychosurgery, procedures are currently under strict control, and the example of the Cingulotomy Committee at the Massachusetts General Hospital is discussed. Finally, future directions of psychosurgery and somatic therapies are explored, including transcranial magnetic stimulation, vagal nerve stimulation, deep brain stimulation, gene therapy, and stem cell therapy. In summary, this review provides a concise yet comprehensive introduction to the history, current practice, and future trends of neurosurgery for psychiatric disorders.
Mashour
George A
GA
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. gmashour@partners.org
Walker
Erin E
EE
Martuza
Robert L
RL
D001921:Brain / Q000503:physiopathology / Q000601:surgery*; D004599:Electric Stimulation Therapy / Q000639:trends; D028741:Ethics Committees, Clinical / Q000639:trends; D015316:Genetic Therapy / Q000639:trends; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D001523:Mental Disorders / Q000503:physiopathology / Q000601:surgery*; D009434:Neural Pathways / Q000503:physiopathology / Q000601:surgery; D011612:Psychosurgery / Q000941:ethics / Q000266:history* / Q000639:trends