title: Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery.
abstract: Brain surgery to promote behavioral or affective changes in humans remains one of the most controversial topics at the interface of medicine, psychiatry, neuroscience, and bioethics. Rapid expansion of neuropsychiatric deep brain stimulation has recently revived the field and careful appraisal of its 2 sides is warranted: namely, the promise to help severely devastated patients on the one hand and the dangers of premature application without appropriate justification on the other. Here, we reconstruct the vivid history of the field and examine its present status to delineate the progression from crude freehand operations into a multidisciplinary treatment of last resort. This goal is accomplished by a detailed reassessment of numerous case reports and small-scale open or controlled trials in their historical and social context. The different surgical approaches, their rationale, and their scientific merit are discussed in a manner comprehensible to readers lacking extensive knowledge of neurosurgery or psychiatry, yet with sufficient documentation to provide a useful resource for practitioners in the field and those wishing to pursue the topic further.
authors.affiliation: Institute for Neurophysiology, University of Cologne, Cologne, Germany. Electronic address: felix@neumaier-net.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Neumaier
authors.affiliation: Institute for Anatomy, University of Cologne, Cologne, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Paterno
authors.affiliation: Institute for Neurophysiology, University of Cologne, Cologne, Germany.
authors.forename: Serdar
authors.initials: S
authors.lastname: Alpdogan
authors.affiliation: Institute for Neurophysiology, University of Cologne, Cologne, Germany.
authors.forename: Etienne E
authors.initials: EE
authors.lastname: Tevoufouet
authors.affiliation: Institute for Neurophysiology, University of Cologne, Cologne, Germany.
authors.forename: Toni
authors.initials: T
authors.lastname: Schneider
authors.affiliation: Institute for Neurophysiology, University of Cologne, Cologne, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hescheler
authors.affiliation: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
authors.forename: Walid
authors.initials: W
authors.lastname: Albanna
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000601:surgery; D046690:Deep Brain Stimulation / Q000379:methods; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000523:psychology / Q000601:surgery; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D011612:Psychosurgery / Q000379:methods*; D013238:Stereotaxic Techniques
keywords: Ablative surgery; Frontal lobotomy/leucotomy; Functional stereotactic microsurgery; Neuromodulation; Neuropsychiatric deep brain stimulation (DBS); Treatment-resistant mental disorders