Introduction: Surgical interventions such as stereotactic radiosurgery and magnetic resonance-guided focused ultrasound, and neuromodulatory interventions such as deep brain stimulation (DBS) and vagal nerve stimulation, are under investigation to remediate psychiatric conditions resistant to conventional therapies involving drugs and psychological supports. Objective: Given the complicated history of psychiatric neurosurgery and its renaissance today, we sought to examine current perceptions and predictions about the field among practicing functional neurosurgeons. Methods: We designed a 51-question online survey comprising Likert-type, multiple-choice, and rank-order questions and distributed it to members of the American Society for Stereotactic and Functional Neurosurgery (ASSFN). Descriptive and inferential statistical analyses were performed on the data. Results: We received 38 completed surveys. Half (n = 19) of responders reported devoting at least a portion of their clinical practice to psychiatric neurosurgery, utilizing DBS and treating obsessive compulsive disorder (OCD) most frequently overall. Respondents indicated that psychiatric neurosurgery is more medically effective (OR 0, p = 0.03242, two-sided Fisher’s exact test) and has clearer clinical indications for the treatment of OCD than for the treatment of depression (OR 0.09775, p = 0.005137, two-sided Fisher’s exact test). Seventy-one percent of all respondents (n = 27) supported the clinical utility of ablative surgery in modern neuropsychiatric practice, 87% (n = 33) agreed that ablative procedures constitute a valid treatment alternative to DBS for some patients, and 61% (n = 23) agreed that ablative surgery may be an acceptable treatment option for patients who are unlikely to comply with postoperative care. Conclusions: This up-to-date account of practices, perceptions, and predictions about psychiatric neurosurgery contributes to the knowledge about evolving attitudes over time and informs priorities for education and further surgical innovation on the psychiatric neurosurgery landscape.

1.
Kvaale
EP
,
Haslam
N
,
Gottdiener
WH
.
The ‘side effects’ of medicalization: a meta-analytic review of how biogenetic explanations affect stigma
.
Clin Psychol Rev
.
2013
Aug
;
33
(
6
):
782
94
.
[PubMed]
0272-7358
2.
Lipsman
N
,
Bernstein
M
,
Lozano
AM
.
Criteria for the ethical conduct of psychiatric neurosurgery clinical trials
.
Neurosurg Focus
.
2010
Aug
;
29
(
2
):
E9
.
[PubMed]
1092-0684
3.
Müller
S
(
Illes
J
, editor
).
“Ethical challenges of modern psychiatric neurosurgery,” in Neuroethics: Anticipating the Future
.
Oxford, UK
:
Oxford University Press
;
2017
. pp.
235
63
.
4.
Nuttin
B
,
Wu
H
,
Mayberg
H
,
Hariz
M
,
Gabriëls
L
,
Galert
T
, et al
Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders
.
J Neurol Neurosurg Psychiatry
.
2014
Sep
;
85
(
9
):
1003
8
.
[PubMed]
0022-3050
5.
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
(
2
):
103
10
.
[PubMed]
1011-6125
6.
Mendelsohn
D
,
Lipsman
N
,
Bernstein
M
.
Neurosurgeons’ perspectives on psychosurgery and neuroenhancement: a qualitative study at one center
.
J Neurosurg
.
2010
Dec
;
113
(
6
):
1212
8
.
[PubMed]
0022-3085
7.
Mendelsohn
D
,
Lipsman
N
,
Lozano
AM
,
Taira
T
,
Bernstein
M
.
The contemporary practice of psychiatric surgery: results from a global survey of functional neurosurgeons
.
Stereotact Funct Neurosurg
.
2013
;
91
(
5
):
306
13
.
[PubMed]
1011-6125
8.
Cabrera
LY
,
Bittlinger
M
,
Lou
H
,
Müller
S
,
Illes
J
.
The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage
.
Acta Neurochir (Wien)
.
2018
Mar
;
160
(
3
):
625
35
.
[PubMed]
0001-6268
9.
Lozano
AM
,
Lipsman
N
,
Bergman
H
,
Brown
P
,
Chabardes
S
,
Chang
JW
, et al
Deep brain stimulation: current challenges and future directions
.
Nat Rev Neurol
.
2019
Mar
;
15
(
3
):
148
60
.
[PubMed]
1759-4758
10.
Meng
Y
,
Suppiah
S
,
Mithani
K
,
Solomon
B
,
Schwartz
ML
,
Lipsman
N
. “
Current and emerging brain applications of MR-guided focused ultrasound
,” J. Ther. Ultrasound, vol. 5, Oct.
2017
. [Online]. Available: https://link.springer.com/article/10.1186/s40349-017-0105-z. [Accessed Jun. 4, 2019].
11.
Cabrera
LY
,
Bittlinger
M
,
Lou
H
,
Müller
S
,
Illes
J
.
Reader comments to media reports on psychiatric neurosurgery: past history casts shadows on the future
.
Acta Neurochir (Wien)
.
2018
Dec
;
160
(
12
):
2501
7
.
[PubMed]
0001-6268
12.
Lozano
AM
,
Lipsman
N
.
Probing and regulating dysfunctional circuits using deep brain stimulation
.
Neuron
.
2013
Feb
;
77
(
3
):
406
24
.
[PubMed]
0896-6273
13.
Muller
S
,
Riedmuller
R
,
Van Oosterhout
A
. “
Rivaling paradigms in psychiatric neurosurgery: Adjustability versus quick fix versus minimal-invasiveness
,” Front. Integr. Neurosci., Apr.
2015
. [Online]. Available: https://www.frontiersin.org/articles/10.3389/fnint.2015.00027/full. [Accessed Mar. 25, 2019].
14.
Pepper
J
,
Hariz
M
,
Zrinzo
L
.
Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature
.
J Neurosurg
.
2015
May
;
122
(
5
):
1028
37
.
[PubMed]
0022-3085
15.
R Core Team
.
R: A Language and Environment for Statistical Computing
.
Vienna, Austria
:
R Foundation for Statistical Computing
;
2018
.
16.
Hooper
AK
,
Okun
MS
,
Foote
KD
,
Fernandez
HH
,
Jacobson
C
,
Zeilman
P
, et al
Clinical cases where lesion therapy was chosen over deep brain stimulation
.
Stereotact Funct Neurosurg
.
2008
;
86
(
3
):
147
52
.
[PubMed]
1011-6125
17.
Miguel
EC
,
Lopes
AC
,
McLaughlin
NC
,
Norén
G
,
Gentil
AF
,
Hamani
C
, et al
Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder
.
Mol Psychiatry
.
2019
Feb
;
24
(
2
):
218
40
.
[PubMed]
1359-4184
18.
Na
YC
,
Jung
HH
,
Chang
JW
.
“Focused ultrasound for the treatment of obsessive-compulsive disorder,” in Neurosurgical Treatments for Psychiatric Disorders
.
Springer
;
2015
. pp.
125
41
.
19.
Kim
M
,
Kim
CH
,
Jung
HH
,
Kim
SJ
,
Chang
JW
.
Treatment of major depressive disorder via magnetic resonance–guided focused ultrasound surgery
.
Biol Psychiatry
.
2018
Jan
;
83
(
1
):
e17
8
.
[PubMed]
0006-3223
20.
Morishita
T
,
Fayad
SM
,
Higuchi
MA
,
Nestor
KA
,
Foote
KD
.
Deep brain stimulation for treatment-resistant depression: systematic review of clinical outcomes
.
Neurotherapeutics
.
2014
Jul
;
11
(
3
):
475
84
.
[PubMed]
1933-7213
21.
Holtzheimer
PE
,
Husain
MM
,
Lisanby
SH
,
Taylor
SF
,
Whitworth
LA
,
McClintock
S
, et al
Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial
.
Lancet Psychiatry
.
2017
Nov
;
4
(
11
):
839
49
.
[PubMed]
2215-0366
22.
Bari
AA
,
Mikell
CB
,
Abosch
A
,
Ben-Haim
S
,
Buchanan
RJ
,
Burton
AW
, et al
Charting the road forward in psychiatric neurosurgery: proceedings of the 2016 American Society for Stereotactic and Functional Neurosurgery workshop on neuromodulation for psychiatric disorders
.
J Neurol Neurosurg Psychiatry
.
2018
Aug
;
89
(
8
):
886
96
.
[PubMed]
0022-3050
23.
R.
Ramasubbu
, et al
, “
Randomized double-blind study of long vs. short pulse width subcallosal cingulate stimulation for treatment-resistant depression
,” Social Science Research Network, Rochester, NY, SSRN Scholarly Paper ID 3416717, Mar.
2019
.
24.
Crowell
AL
,
Riva-Posse
P
,
Holtzheimer
PE
,
Garlow
SJ
,
Kelley
ME
,
Gross
RE
, et al
Long-term outcomes of subcallosal cingulate deep brain stimulation for treatment-resistant depression
.
Am J Psychiatry
.
2019
Nov
;
176
(
11
):
949
56
.
[PubMed]
0002-953X
25.
Cunningham
CT
,
Quan
H
,
Hemmelgarn
B
,
Noseworthy
T
,
Beck
CA
,
Dixon
E
, et al
Exploring physician specialist response rates to web-based surveys
.
BMC Med Res Methodol
.
2015
Apr
;
15
(
1
):
32
.
[PubMed]
1471-2288
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.