Psychiatric disorders such as depression and obsessive-compulsive disorder (OCD) can have a major impact on quality of life. Some patients may experience conditions that are difficult to treat despite undergoing various therapies, such as medications, psychotherapy, and non-surgical therapies. In certain conditions, psychosurgery may be one of the options considered.
With the development of medical technology, modern psychosurgery is now performed using more targeted and precise techniques to influence brain tissue or circuits associated with disease symptoms. So, what is psychosurgery, when is it needed, and how is the procedure performed? Here is the explanation.
Psychosurgery is a neurosurgical procedure aimed at modulating the activity of specific brain tissue or circuits associated with symptoms of psychiatric disorders. Unlike lobotomy, which was performed in the past, modern psychosurgery uses a much more targeted and precise approach.
This procedure is generally performed using stereotactic techniques, allowing doctors to determine specific targets within the brain with the assistance of imaging and navigation technology. Psychosurgical approaches may include neuromodulation, such as brain stimulation, as well as ablation or lesioning of specific areas of the brain. The choice of method depends on the patient's condition, diagnosis, therapeutic target, and the results of the medical team's evaluation.
With advances in neuroscience and medical technology, modern psychosurgery focuses on brain tissue or circuits associated with disease symptoms rather than causing extensive damage to brain areas as in procedures performed in the past. Therefore, modern psychosurgery is part of functional neurosurgery, which is performed in a targeted and highly selective manner in certain patients.
Psychosurgery is not given simply because someone has a psychiatric disorder. Usually, the procedure is only considered when:
Because the evaluation process is complex, the decision to perform psychosurgery may take several weeks to several months.
Major depressive disorder can cause:
In a small proportion of patients, depression can become a condition that is very difficult to treat despite receiving various therapies. In certain conditions, neuromodulation approaches such as vagus nerve stimulation (VNS) may be considered.
In the United States, the FDA has a specific indication for the use of VNS in adult patients with chronic or recurrent depression who meet certain criteria and have not responded adequately to several antidepressant therapies.
OCD is a disorder characterized by:
For example, a person may be extremely afraid of germs and wash their hands repeatedly even though their hands are already clean.
In severe and difficult-to-treat OCD, deep brain stimulation (DBS) may be one of the options for patients who meet certain criteria. The FDA has a Humanitarian Device Exemption for certain DBS systems for chronic and severe OCD that is difficult to treat.
Severe aggressive behavior may occur in some psychiatric or neurological conditions. Examples include:
Neurosurgical approaches for conditions such as these remain highly selective and continue to be developed. Therefore, the procedure cannot be performed on every patient and requires very strict evaluation.
Psychosurgery is also beginning to be studied for addiction-related conditions, such as alcohol addiction, drug addiction, or gambling addiction. This approach is based on the understanding that addiction is associated with brain networks that regulate reward, motivation, impulse control, and decision-making.
However, psychosurgery for addiction is still in the research stage in many contexts and has not yet become a routine treatment for all patients.
Psychosurgery is not performed solely based on a request from the patient or family. Because psychiatric disorders are complex conditions, the decision to perform this procedure must undergo a multidisciplinary evaluation involving a psychiatrist, functional neurosurgeon, and other healthcare professionals as needed.
The psychiatrist will assess the diagnosis, severity of the disease, treatment history, and response to the therapies that have been provided. Meanwhile, the functional neurosurgeon will assess the feasibility of the procedure, the appropriate target and technique, as well as its potential benefits and risks.
The team will also evaluate previously undergone therapies, such as medications, psychotherapy, and non-surgical therapies such as ECT or TMS, according to indications. If these various therapies have been provided optimally but symptoms remain severe or difficult to control, psychosurgery may be considered.
This evaluation process ensures that the patient meets the criteria for the procedure and understands the benefits, risks, and need for monitoring after the procedure. After the procedure, the patient will still require monitoring to assess the treatment response and, for certain neuromodulation procedures, adjust the stimulation as needed.
Psychosurgery is not like what many people imagine, in which the skull must be widely opened. Modern psychosurgery generally uses stereotactic techniques with much smaller access points and highly specific targets. There are two main approaches to psychosurgery:
In this method, specialized devices are used to influence brain activity. One example is Deep Brain Stimulation (DBS), in which the procedure involves:
Another method is Vagus Nerve Stimulation (VNS), which involves delivering stimulation through the vagus nerve using a device implanted in the body.
Unlike neuromodulation, this method aims to create a highly targeted change or lesion in a specific area of the brain. The procedure is performed with the assistance of a stereotactic system to determine the target precisely.
Ablation techniques may use specific technologies depending on the patient's condition, the brain target, and the available facilities. The advantage of the stereotactic approach is that doctors can target a highly specific area without performing surgery that requires extensive opening of the skull.
Psychosurgery is not lobotomy and is not a first-line treatment option for psychiatric disorders. This procedure is part of modern functional neurosurgery that uses stereotactic technology, brain imaging, neuromodulation, or ablation to target specific brain tissue more precisely.
Psychosurgery is only considered for certain patients with difficult-to-treat disorders after various standard therapies have been evaluated and optimally administered. The goal is not to change the patient's personality, but rather to help control disease symptoms through intervention in the brain tissue or circuits involved.
Because it is a complex procedure, psychosurgery requires evaluation and collaboration by a multidisciplinary team, particularly psychiatrists and functional neurosurgeons, with the involvement of other medical professionals as needed based on the patient's condition.
National Hospital is supported by modern medical technology, supporting facilities, as well as experienced specialist doctors and medical professionals to help conduct comprehensive evaluations and determine appropriate treatment options. Each procedure is considered individually based on the diagnosis, severity, treatment history, response to treatment, as well as the benefits and risks for the patient.
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