Psychosurgery

Psychosurgery involves severing or otherwise disabling areas of the brain totreat a personality disorder, behavior disorder, or other mental illness. Modern psychosurgical techniques target the pathways between the limbic system (the portion of the brain on the inner edge of the cerebral cortex) that is believed to regulate emotions, and the frontal cortex, where thought processesare seated.

Lobotomy is a psychosurgical procedure involving selective destruction of connective nerve fibers or tissue. It is performed on the frontal lobe of the brain and its purpose is to alleviate mental illness and chronic pain symptoms.The bilateral cingulotomy, a modern psychosurgical technique which has replaced the lobotomy, is performed to alleviate mental disorders such as major depression, bipolar disorder, or obsessive-compulsive disorder (OCD), which have not responded to psychotherapy, behavioral therapy, electroshock, or pharmacologic treatment. Bilateral cingulotomies are also performed to treat chronic pain in cancer patients.

Psychosurgery should be considered only after all other non-surgical psychiatric therapies have been fully explored. Much is still unknown about the biology of the brain and how psychosurgery affects brain function.

Psychosurgery, and lobotomy in particular, reached the height of use just after World War II. Between 1946 and 1949, the use of the lobotomy grew from 500to 5,000 annual procedures in the United States. At that time, the procedurewas viewed as a possible solution to the overcrowded and understaffed conditions in state-run mental hospitals and asylums. Known as prefrontal or transorbital lobotomy, depending on the surgical technique used and area of the brain targeted, these early operations were performed with surgical knives, electrodes, suction, or ice picks, to cut or sweep out portions of the frontal lobe.

Today's psychosurgical techniques are much more refined. Instead of going in"blind" to remove large sections on the frontal lobe, as in these early operations, neurosurgeons use a computer-based process called stereotactic magnetic resonance imaging to guide a small electrode to the limbic system (brain structures involved in autonomic or automatic body functions and some emotion and behavior). There an electrical current burns in a small lesion (usually 1/2 in in size). In a bilateral cingulotomy, the cingulate gyrus, a small section of brain that connects the limbic region of the brain with the frontal lobes, is targeted. Another surgical technique uses a non-invasive tool known asa gamma knife to focus beams of radiation at the brain. A lesion forms at the spot where the beams converge in the brain.

Candidates for cingulotomies or other forms of psychosurgery undergo a rigorous screening process to ensure that all possible non-surgical psychiatric treatment options have been explored. Psychosurgery is only performed with the patient's informed consent.

Ongoing behavioral and medication therapy is often required in OCD patients who undergo cingulotomy. All psychosurgery patients should remain under a psychiatrist's care for follow-up evaluations and treatment.

As with any type of brain surgery, psychosurgery carries the risk of permanent brain damage, though the advent of non-invasive neurosurgical techniques, such as the gamma knife, has reduced the risk of brain damage significantly.

In a 1996 study at Massachusetts General Hospital, over one-third of patientsundergoing cingulotomy demonstrated significant improvements after the surgery. And, in contrast to the bizarre behavior and personality changes reportedwith lobotomy patients in the 1940s and 50s, modern psychosurgery patients have demonstrated little post-surgical losses of memory or other high level thought processes.

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