Ablative Procedures in Psychiatric Neurosurgery

From the advent of the frontal leucotomy/lobotomy in 1936 to the present day, modern ablative neurosurgery has been used in the treatment of psychiatric disease. This chapter reviews the ablative procedures currently being performed, and the psychiatric conditions which they treat, including depression, bipolar disorder, obsessive-compulsive disorder, and addiction. In discussing each disorder, emphasis is given to the relevant functional circuitry, and how these pathways are disrupted. Afterwards, the four primary neurosurgical ablative procedures used to treat psychiatric disease are examined: the anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and limbic leucotomy. In these sections, the areas targeted for ablation are identified, followed by a review of procedural outcomes as found in the literature.