(Psychosurgery: from lesion to insertion)
In the first half of the 1900’s the first real steps into psychosurgery were made. Tens of thousands prefrontal leucotomies (lobotomies) were performed on patients with different psychiatric disorders. Even though this rather crude brain lesioning procedure was already regarded unethical, risky and unscientific, the neurologist Egas Moniz still received a Noble Prize for his work on lobotomies in 1949.
After the introduction of the stereotactic frame the selectivity of subcortical lesioning strongly improved and lobotomies were quickly replaced by stereotactic psychosurgery. However, with the introduction of psychoactive medication in the 1950’s and 1960’s the interest in the invasive and irreversible treatment of psychosurgery subsided strongly.
Since the emergence of deep brain stimulation (DBS) in the 1990’s, the returning interest in the field of neurosurgery has been remarkable. DBS involves the insertion of electrodes that deliver electrical impulses to targeted areas of the brain. Opposed to ablative surgery, DBS is an adjustable and reversible intervention. For several psychiatric disorders the results are promising and the number of psychiatric patients treated with DBS is growing steadily (±300 DBS for obsessive-compulsive disorder patients). Today, DBS is considered a promising treatment for psychiatric disorders and for psychosurgery it seems, third time‘s a charm.