Psychosurgery, or neurosurgery, is a surgical procedure which involves destroying microscopic amounts of brain tissue in target areas of the brain. It may be performed on incapacitating and otherwise treatmeant-resistant cases of OCD, but it is usually used as a last resort. Since the prefrontal lobotomy was used so indiscriminately and unjustly in the history of mental institutions, certain criteria must be met before one can have these sort of procedures done in order to protect patient's safety:

•  The illness must have persisted for longer than five years.

•  The case must be extremely severe, inhibiting functioning to a great enough degree that one is unable to care for oneself.

•  All other treatment options must have been attempted first and failed to provide relief, or the side effects of medication have been intolerable.

•  One must be between the ages of twenty and sixty-five.

•  There must be no other complicating brain problems or history of substance abuse.

Since this surgery is irreversible, it must be considered very carefully. It can also have permanent side effects, including hemorrhage, seizures, increased fatigue, apathy, and poor memory.

The anterior cingulotomy and anterior capsulotomy are the two most common types of neurosurgery performed. Two other forms sometimes employed are the subcaudate tractotomy or limbic leucotomy. Don't worry if these names don't mean much to you. The main idea is that all of these procedures attempt to interrupt nerve pathways in areas of the brain implicated OCD. All surgeries except for the anterior capsulotomy are performed by inserting thin electric probes into both sides of the skull. The anterior capsultomy may be performed using an instrument called the Leksell Gamma Knife. In actuality it functions more like a laser than a knife, comprised of a focused beam of gamma rays which can lesion the selected areas without requiring the penetration of the skull.


Additional Resources