Advertisement

Functional Stereotactic Neurosurgery for Psychiatric Disorders: an Experience in Belgium and The Netherlands

  • P. Cosyns
  • J. Caemaert
  • W. Haaijman
  • C. van Veelen
  • J. Gybels
  • J. van Manen
  • J. Ceha
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 21)

Abstract

This chapter addresses the difficult and often contentious subject of psychosurgery which has been defined as “a neurosurgical intervention to sever fibres connecting one part of the brain with another, or to remove or destroy brain tissue with the intent of modifying or altering severe disturbance of behaviour, thought content or mood”. The authors have traced the historical development of psychosurgery and brought out the fact that it is those patients suffering from anxiety, depression and obsessive compulsive illness who throughout this history of psychosurgery have benefited most. They also refer to the “taming effects” of the old leucotomy (obsolete since the mid-1950’s) which had proved useful in the management of certain behaviour disorders of schizophrenia. This latter effect often left patients with severe blunting of personality, but the operation, judged in the context of the alternatives available at the time was better than nothing for this unfortunate group. It allowed 20% to return to life in the community. However, as the authors emphasize this became history with the discovery in the 1950’s of the major tranquilizers and effective pharmacological agents for the treatment of depression and anxiety which has transformed psychiatry. Nonetheless, some patients remain resistant to the newer treatments and it is this which keeps an interest in psychosurgery alive. The introduction of stereo-tactic techniques, increasingly accurate imaging techniques for target identification and precise lesions have all contributed to a very low morbidity of modern procedures. It is now well recognised that Psychiatrists and Neurosurgeons must work in close partnership to ensure the cases are appropriately selected.

Keywords

Obsessive Compulsive Disorder Obsessive Compulsive Disorder Obsessive Compulsive Disorder Patient Orbital Roof Dorsomedial Nucleus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    APA (1989) American psychiatric glossary. In: Stone EM (ed) American Psychiatric Press, Washington.Google Scholar
  2. 2.
    Ballantine HT Jr, Cassidy WL, Flanagan NB, Marino R (1967) Stereotactic anterior cingulotomy for neuropsychiatric illness and intractable pain. J Neurosurg 26: 488–495.PubMedCrossRefGoogle Scholar
  3. 3.
    Ballantine HT, Levy BS, Dagi TF (1977) Cingulotomy for psychiatric illness. Report of 13 years’ experience. In: Sweet WH, Obrador S, Martin-Rodriguez JG (eds) Neurosurgical treatment in psychiatry, pain and epilepsy. University Park Press, Baltimore, 333-353.Google Scholar
  4. 4.
    Belgian Biomedical Ethical Committee (1991) Statement. National Fund for Scientific Research, Brussels, November.Google Scholar
  5. 5.
    Bregging P (1980) Brain-Disabling therapies. In: Valenstein E (ed) The psychosurgery debate. Freeman, San Francisco, pp 467–492.Google Scholar
  6. 6.
    Burzaco J (1981) Stereotactic surgery in the treatment of obsessive-compulsive neurosis. In: Perris C, Struwe G, Jansson B (eds) Biological psychiatry 1981. Proceedings of the Third World Congress on Biological Psychiatry. Elsevier, Amsterdam, pp 1103-1109.Google Scholar
  7. 7.
    Crosby EC, Humphrey T (1944) Studies of the vertebrate telecephalon. III. The amygdaloid complex in the shrew (blarina brevicauda). J Comp Neurol 81: 285–305.CrossRefGoogle Scholar
  8. 8.
    Crow H (1977) The treatment of anxiety and obsessionality with chronically implanted electrodes. In: Smith JS, Kiloh LG (eds) Psychosurgery and society. Pergamon, Oxford, pp 67–74.Google Scholar
  9. 9.
    Crow HJ, Cooper R, Philips DG (1961) Controlled multifocal frontal leucotomy for psychiatric illness. Neurol Neurosurg Psychiatry 24: 353–360.CrossRefGoogle Scholar
  10. 10.
    Culliton B (1976) Psychosurgery: National Commission issues surprisingly favorable report. Science 194: 299–301.PubMedCrossRefGoogle Scholar
  11. 11.
    Department of Health, Education, and Welfare (1977) Protection of human subjects, use of psychosurgery in practice and research: report and recommendations for public comment. Federal Register, May 23, 26318-26332.Google Scholar
  12. 12.
    American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd rev Ed. Washington, DC.Google Scholar
  13. 13.
    Dutch Health Council (1990) Neurochirurgische behandeling van patiënten met zeer ernstige psychische aandoeningen. Gezondheidsraad, Publicatie 90/21, Den Haag.Google Scholar
  14. 14.
    Freeman W, Watts JW (1950) Psychosurgery in the treatment of mental disorders and intractable pain, 2nd Ed. Thomas, Springfield, 111.Google Scholar
  15. 15.
    Hassler R (1982) Stereotaxic surgery for psychiatric disturbances. In: Schaltenbrand, Walker (eds) Stereotaxy of the human brain. Thieme, Stuttgart, pp 570–590.Google Scholar
  16. 16.
    Hay P, Sachdev (1992) The present status of psychosurgery in Australia and New-Zealand. Med J Aust 157: 17–19.PubMedGoogle Scholar
  17. 17.
    Herner T (1961) Treatment of mental disorders with frontal stereotactic thermolesions. Acta Psychiatr Neurol Scand [Suppl 36].Google Scholar
  18. 18.
    World Health Organisation (1992) ICD-10 Classification of mental and behavioural disorders. Geneva.Google Scholar
  19. 19.
    Jacobson S, Trojanowski JQ (1975) Amygdaloid projections to prefrontal granular cortex in rhesus monkey demonstrated with horseradish peroxidase. Brain Res 100: 132–139.PubMedCrossRefGoogle Scholar
  20. 20.
    Kelly D (1973) Psychosurgery and the limbic system. Postgrad Med J 49: 825–833.PubMedCrossRefGoogle Scholar
  21. 21.
    Knight G (1964) The orbital cortex as an objective in the surgical treatment of mental illness. The results of 450 cases of open operation and the development of the stereotactic approach. Br J Surg 51(2): 114–124.PubMedCrossRefGoogle Scholar
  22. 22.
    Knight G (1965) Stereotactic tractotomy in the surgical treatment of mental illness. J Neurol Neurosurg Psychiatry 28: 304–310.PubMedCrossRefGoogle Scholar
  23. 23.
    Knight G (1972) Bifrontal stereotaxic tractotomy in the substantia innominata. An experience of 450 cases. In: Hitchcock E, Laitinen L, Vaernet K (eds) Psychosurgery. Thomas, Springfield, 111, pp 267–277.Google Scholar
  24. 24.
    Knight G (1973) Further observations from an experience of 660 cases of stereotactic tractotomy. Postgrad Med J 49: 845–854.PubMedCrossRefGoogle Scholar
  25. 25.
    Leksell L, Larsson B, Andersson B, Rexed B, Sourander P, Mair W (1960) Lesions in the depth of the brain produced by a beam of high energy protons. Acta Radiol (Stockh) 54: 251–264.CrossRefGoogle Scholar
  26. 26.
    Leksell L (1971) Stereotaxis and radiosurgery. An operative system. Thomas, Springfield, 111, pp 1–69.Google Scholar
  27. 27.
    Leksell L, Backlund E-O (1979) Stereotactic gamma capsulotomy. In: Hitchcock ER, Ballantine HR Jr, Meyerson BA (eds) Modern concepts in psychiatric surgery. Elsevier Biomedical Press, Amsterdam, pp 213–216.Google Scholar
  28. 28.
    Lichterman B (1992) On the history of psychosurgery in Russia. Personal written communication of 5 pages.Google Scholar
  29. 29.
    Lovett L, Shaw D (1987) Outcome in bipolar affective disorder after stereotactic tractotomy. Br J Psychiatry 151: 113–116.PubMedCrossRefGoogle Scholar
  30. 30.
    Marino R (1977) Stereotactic anatomy and vascularization of cingulate gyrus and adjacent areas. In: Sweet WH (ed) Obrador neurosurgical treatment of psychiatry pain and epilepsy. University Park Press, Congress 75, pp 321-332.Google Scholar
  31. 31.
    Mark V, Ervin F (1970) Violence and the brain. Harper and Row, New York.Google Scholar
  32. 32.
    Maxwell-Jones (1968) Beyond the therapeutic community. Yale University Press, New Haven.Google Scholar
  33. 33.
    Merskey H (1991) Ethical aspects of the physical manipulation of the brain. In: Bloch S, Chodoff P (eds) Psychiatric ethics, 2nd Ed. Oxford Medical Publications, Oxford, pp 185–214.Google Scholar
  34. 34.
    Meyer A, Beck E, McLardy T (1947) Prefrontal leukotomy. A neuro-anatomical report. Brain 70: 18–49.PubMedCrossRefGoogle Scholar
  35. 35.
    Meyer A, Beck E (1954) Prefrontal leucotomy and related operations. Anatomic aspects of success and failure. Churchill Livingstone, Thomas, Edinburgh.Google Scholar
  36. 36.
    Meyerson BA (1977) Stereotactic anterior capsulotomy in the treatment of obsessive-compulsive neurosis. In: Carrea R (ed) Neurological surgery. International Congress Series No. 433. Exerpta Medica, Amsterdam, pp 307-312.Google Scholar
  37. 37.
    Meyerson BA, Bergström M, Greitz T (1979) Target localization with the aid of computed tomography. In: Hitchcock E, Ballantine HT Jr, Meyerson BA (eds) Modern concepts in psychiatric surgery. Elsevier Biomedical Press, Amsterdam, pp 217–224.Google Scholar
  38. 38.
    Meyerson BA (1988) The role of anterior internal capsulotomy in psychiatric surgery. In: Lundsford LD (ed) Modern stereotactic neurosurgery. Martinus Nijhoff, Boston, pp 353–364.CrossRefGoogle Scholar
  39. 39.
    Mindus P (1991) Thesis: capsulotomy in anxiety disorders. A multidisciplinary study. Karolinska Institute, Stockholm, Sweden.Google Scholar
  40. 40.
    Moniz E (1936) Tentatives opératoires dans le traitement de certaines psychoses. Masson, Paris.Google Scholar
  41. 41.
    Narabayashi H, Shima F (1973) Which is the better amygdala target, the medial or lateral nuclei (For behaviour problems and paroxysm in epileptics). In: Laitinen LV, Livingston KE (eds) Surgical approaches in psychiatry. Medical and Technical Publishing Co, Lancaster, pp 129–134.Google Scholar
  42. 42.
    National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research (1977) Use of psychosurgery in practice and research: report and recommendation for public comment. Department of HEW, Federal Register May 23, 26318-26332.Google Scholar
  43. 43.
    Newcombe RL (1972) Landmarks for lesions in the substantia innominata. In: Hitchcock E, Laitinen L, Vaernet K (eds) Psychosurgery. Thomas, Springfield, 11, pp 289–290.Google Scholar
  44. 44.
    Newcombe RL (1973) Anatomical placement of lesions in the ventromedial segment of the frontal lobe. In: Laitinen LV, Livingston KE (eds) Surgical approaches in psychiatry. Medical and Technical Publishing Co, Lancaster, pp 83–89.Google Scholar
  45. 45.
    Nys H (1988) Psychosurgery and personality-some legal considerations. In: Brihaye J, Calliauw L, Loew P, van den Bergh R (eds) Personality and neurosurgery. Acta Neurochir (Wien) [Suppl] 44: 170-172.Google Scholar
  46. 46.
    Schaltenbrand G, Wahren W (1977) Atlas for sterotaxy of the human brain. Thieme, Stuttgart.Google Scholar
  47. 47.
    Scoville WB (1972) Psychosurgery and other lesions of the brain affecting human behaviour. In: Hitchcock E, Laitinen L, Vaernet K (eds) Psychosurgery. Thomas, Springfield, 111, pp 5–21.Google Scholar
  48. 48.
    Storm van Leeuwen W (1982) Neuro-physio-surgery in the Netherlands since 1971. Acta Neurochir (Wien) 61: 249–256.CrossRefGoogle Scholar
  49. 49.
    Talairach J, Hecaen H, David M (1949) Lobotomie préfrontale limitée par électrocoagulation des fibres thalamofrontales à leur émergence du bras anterieur de la capsule interne. In: VI Congress Neurologique International. Masson, Paris, p 141.Google Scholar
  50. 50.
    Valenstein E (1980) The psychosurgery debate. Scientific, legal and ethical perspectives. Freeman, San Francisco.Google Scholar

Copyright information

© Springer-Verlag/Wien 1994

Authors and Affiliations

  • P. Cosyns
    • 1
  • J. Caemaert
    • 2
  • W. Haaijman
    • 3
  • C. van Veelen
    • 4
  • J. Gybels
    • 5
  • J. van Manen
    • 6
    • 7
  • J. Ceha
    • 8
  1. 1.University of AntwerpenAntwerpBelgium
  2. 2.University Hospital of GentGhentBelgium
  3. 3.Hospital for Psychotheraphy “Overwaal”LentThe Netherlands
  4. 4.University Hospital of UtrechtUtrechtThe Netherlands
  5. 5.Catholic University of LeuvenLouvainBelgium
  6. 6.Academic Medical CenterAmsterdamThe Netherlands
  7. 7.University Hospital of GroningenGroningenThe Netherlands
  8. 8.Psychiatric Hospital “Ursula Kliniek”WassenaarThe Netherlands

Personalised recommendations