Background: Interest in neurosurgery for psychiatric diseases (NPD) has grown globally. We previously reported the results of a survey of North American functional neurosurgeons that evaluated general attitudes towards NPD and the future directions of the field. Objectives: The purpose of this study was to expand on our previous work and obtain a snapshot in time of global attitudes towards NPD among practicing functional neurosurgeons. We measure general and regional trends in functional neurosurgery and focus specifically on surgery for mind and mood, while exploring the future prospects of the field. Methods: We designed an online survey and distributed it electronically to 881 members of the following international organizations: World Society for Stereotactic and Functional Neurosurgery, European Society for Stereotactic and Functional Neurosurgery, Asian-Australasian Society for Stereotactic Functional Neurosurgery and the South and Latin American Society for Stereotactic and Functional Neurosurgery. Subsequent statistical and thematic analysis was performed on the data obtained. Results: Of 881 surveys distributed, 106 were returned (12.8%). Eighty-two percent of functional neurosurgeon respondents were fellowship trained, with movement disorders and pain making up the majority of their practice. Psychiatric indications are the most frequently treated conditions for 34% of survey respondents, and over half of participants (51%) perform epilepsy surgery. Of the psychiatric conditions, obsessive-compulsive disorder and depression are the most common disorders treated. The majority of respondents (90%) felt optimistic about the future of NPD. Two thirds cited the reluctance of psychiatrists to refer patients as the greatest obstacle facing the field, and a majority reported that a cultural stigma surrounding psychiatric diseases exists in their community. In response to hypothetical situations involving cognitive and personality enhancement, opinions varied, but the majority opposed enhancement interventions. Regional variations were examined as well and uncovered distinct attitudinal differences depending on geographic location. Conclusions: Surgery for psychiatric conditions is an expanding field within functional neurosurgery. The opinions of international functional neurosurgeons were largely in line with those of their North American colleagues. Optimism regarding the future of NPD predominates, and future editions of this survey can be used to track the evolution of neurosurgeons' attitudes towards NPD and neuroenhancement.

Keywords:
Deep brain stimulation, Neurosurgery for psychiatric disease, Psychiatry, Enhancement
1.
Feldman RP, Goodrich JT: Psychosurgery: a historical overview. Neurosurgery 2001;48:647-657, discussion 657-659.
2.
Wind JJ, Anderson DE: From prefrontal leukotomy to deep brain stimulation: the historical transformation of psychosurgery and the emergence of neuroethics. Neurosurg Focus 2008;25:E10.
3.
DeGrazia D: Enhancement technologies and human identity. J Med Philos 2005;30:261-283.
4.
Hamani C, McAndrews MP, Cohn M, Oh M, Zumsteg D, Shapiro CM, Wennberg RA, Lozano AM: Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Ann Neurol 2008;63:119-123.
5.
Fuchs T: Ethical issues in neuroscience. Curr Opin Psychiatry 2006;19:600-607.
6.
Glannon W: Neuroethics. Bioethics 2006;20:37-52.
7.
Leshner AI: It's time to go public with neuroethics. Am J Bioeth 2005;5:1-2.
8.
Illes J, Blakemore C, Hansson MG, Hensch TK, Leshner A, Maestre G, Magistretti P, Quirion R, Strata P: International perspectives on engaging the public in neuroethics. Nat Rev Neurosci 2005;6:977-982.
9.
Secko DM, Burgess M, O'Doherty K: Perspectives on engaging the public in the ethics of emerging biotechnologies: from salmon to biobanks to neuroethics. Account Res 2008;15:283-302.
10.
Lipsman N, Mendelsohn D, Taira T, Bernstein M: The contemporary practice of psychiatric surgery: results from a survey of North American functional neurosurgeons. Stereotact Funct Neurosurg 2011;89:103-110.
11.
Mendelsohn D, Lipsman N, Bernstein M: Neurosurgeons' perspectives on psychosurgery and neuroenhancement: a qualitative study at one center. J Neurosurg 2010;113:1212-1218.
12.
Lipsman N, Bernstein M, Lozano AM: Criteria for the ethical conduct of psychiatric neurosurgery clinical trials. Neurosurg Focus 2010;29:E9.
© 2013 S. Karger AG, Basel
2013
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