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A narrative review of ablative neurosurgery in refractory mental disorders

Published online by Cambridge University Press:  18 July 2022

Thomas Whitehead  and
Alvaro Barrera Open the ORCID record for Alvaro Barrera [Opens in a new window]
Thomas Whitehead
Affiliation:
Graduated from the University of Oxford in 2020 and is a Foundation Year 2 junior doctor, currently working in Health Education England's Thames Valley Local Office (Deanery), Oxford, UK.
Alvaro Barrera*
Affiliation:
Consultant psychiatrist with Oxford Health NHS Foundation Trust, working at Warneford Hospital, Oxford, and an honorary senior clinical lecturer in the Department of Psychiatry, University of Oxford, UK. He has an interest in severe mental illness, psychopathology, neuroscience and improving in-patient care.
*
Correspondence Dr Alvaro Barrera. Email: alvaro.barrera@psych.ox.ac.uk
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Summary

Neurosurgery for mental disorder (NMD) is currently performed in the UK for cases of severe depressive disorder and obsessive–compulsive disorder refractory to treatment, under stringent regulations as set out under the Mental Health Act 1983. These surgical procedures appear to be effective for a proportion of individuals in this particularly treatment-resistant cohort. The two ablative procedures currently in use in the UK are anterior cingulotomy (ACING) and anterior capsulotomy (ACAPS). After briefly outlining these procedures, their evidence base and how they compare with other neurosurgical procedures, we suggest two ways in which they could be enhanced in terms of precision, namely the use of stereotactic (Gamma Knife®) radiosurgery guided by magnetic resonance imaging as well as a detailed and expanded standardised psychopathological and neuropsychological assessment both before and after surgery. The latter should involve extended long-term follow-up. We then reflect on how such psychopathological and neuropsychological assessments could help to understand why and how these procedures relieve patients’ suffering and distress.

Keywords

Neurosurgery for mental disordersrefractory depressive disorderrefractory obsessive–compulsive disorderanterior cingulateablative NMD
Type
Article
Information
BJPsych Advances , Volume 29 , Issue 6 , November 2023 , pp. 396 - 402
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

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Footnotes

*

The original version of this article was published with the incorrect order of authors. A notice detailing this has been published and the errors rectified in the online PDF and HTML version.

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