title: Neurosurgical treatment of anorexia nervosa: review of the literature from leucotomy to deep brain stimulation.
abstract: This paper reviews the literature on the surgical treatment of refractory anorexia nervosa (AN) and examines how this literature can inform current circuit models of the disease. The literature contains reports of 35 patients undergoing a neurosurgical procedure for the specific treatment of refractory AN, with the first reported operation, a lobotomy, in 1950. All patients were deemed treatment resistant according to contemporary standards, with the nature of the procedure changing with evolving surgical techniques and methods. All procedures targeted the limbic system and, in a majority of cases, were associated with reported symptomatic improvement. Neurosurgery in AN has been, and continues to be, reserved for patients with chronic and life-threatening illness, for whom conventional treatment has failed. Early procedures, which were viewed as life-saving measures, were crude by today's standards but targeted anatomic structures and pathways implicated in modern models of AN. The last decade has seen a concerted effort in elucidating the neurocircuitry underlying prominent etiologic and maintaining factors in AN, including mood, anxiety and dysfunctional reward processing. This has translated into the development of novel, focused therapeutic options for patients with treatment-refractory AN.
authors.affiliation: Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Nir
authors.initials: N
authors.lastname: Lipsman
authors.forename: D Blake
authors.initials: DB
authors.lastname: Woodside
authors.forename: Peter
authors.initials: P
authors.lastname: Giacobbe
authors.forename: Andres M
authors.initials: AM
authors.lastname: Lozano
mesh_terms: D000856:Anorexia Nervosa / Q000503:physiopathology / Q000601:surgery*; D046690:Deep Brain Stimulation; D006801:Humans; D008032:Limbic System / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures; D017397:Prefrontal Cortex / Q000601:surgery; D011612:Psychosurgery; D013238:Stereotaxic Techniques
keywords: anorexia nervosa; deep brain stimulation; leucotomy; neurosurgery