In contrast to the other areas of functional neurosurgery, psychosurgery has remained basically empiric and unchanged since the seventies, except for the recent suggestion to use chronic stimulation instead of ablative surgery. In this study, the authors investigated the value of SPECT abnormalities to guide psychosurgery and correlated the surgical results with the postoperative SPECT. This new approach, SPECT-based tailored psychosurgery, was applied in 4 of 11 patients referred for surgery, who fulfilled the inclusion criteria adopted. Excellent results were obtained in all of them after a follow-up of 30–52 months. Postoperative SPECT normalized in every case. We conclude, based on this small series, that it is possible to individualize and lateralize (tailor) psychosurgical procedures for every patient and that, to achieve this goal, SPECT is a rather impressive means and that postoperative SPECT closely correlated with the surgical results.

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