Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues

Some patients with obsessive-compulsive disorder or depression have severe chronic illness that is refractory to the best conventional treatment. For them, modem neurosurgical procedures remain a therapeutic option. This article considers the efficacy and safety of current lesion procedures. The evidence has important limitations but sheds light on critical issues in assessing the long-term effectiveness and morbidity associated with existing procedures, including anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leucotomy. The same methodologic issues arise when considering newer nondestructive techniques in development for intractable psychiatric illness, including deep brain stimulation. Determining the effectiveness and side effect burden of neurosurgery for intractable psychiatric illness is a task primarily for psychiatrists, collaborating closely with neurosurgeons and other clinical neuroscientists in specialized multidisciplinary teams.