The cases that are subsidiary of surgery for psychiatric disorder, are those that present a long evolution and that have not improved, or have relapsed after the medical treatment. This treatment must have been carried out for an adequate period of time and exhaustively, as well as psychotherapy.
What are the most frequent psychiatric disorders that may require surgery?
It is a surgery that is performed in very few centers in the world, so the casuistry is not very extensive, but the results that have been obtained so far are very positive. In these patients who had no other medical alternative, the most frequent indications are obsessive-compulsive disorder, depression, anorexia nervosa, refractory aggression and Gilles de la Tourette syndrome.
If a patient with one of these disorders in a severe form, has not been able to improve with drugs for a reasonable time, surgery may be a good alternative.
What is surgery for the treatment of a psychiatric disorder?
There are several surgical options and they must be adapted to the patient’s profile. At the Functional Neurosurgery Unit of the Ruber International Hospital we perform all the techniques and, depending on the case, we can choose one or the other.
On the one hand, there is deep brain stimulation, which consists in the implantation of an electrode approximately one millimeter thick in a certain brain area, depending on the disease, and this is connected to a subcutaneous battery, which generates a pacemaker-like electricity. It has been proven that this electricity normalizes certain dysfunctional circuits and improves symptoms very significantly.
Another option would be radiofrequency, in which instead of leaving an implanted electrode and treating with electricity, a blockage is generated by thermocoagulation of the areas to be treated, also with a significant reduction of symptoms.
As a third alternative, we have Gamma Knife radiosurgery, in which there is no need to make any type of incision or trephine, and this block is generated with radiation. Unlike the other techniques, it does not require admission, but the onset of its efficacy has a latency of several weeks.