Neurosurgery for mental disorder

David M. B. Christmas is a clinical lecturer in the Department of Psychiatry, Ninewells Hospital and Medical School, Dundee. His research interests include the management of treatment-refractory depression, electroconvulsive therapy and neurosurgery for mental disorder. Colin Morrison is a specialist registrar in general adult psychiatry and the psychiatry of learning disability, also at Ninewells Hospital and Medical School. His interests include treatment-refractory depression, epilepsy and functional illness in learning disability. Keith Matthews is Professor and Head of the Department of Psychiatry at the University of Dundee (Ninewells Hospital and Medical School, Dundee DD1 9SY, UK). Muftah S. Eljamel is a consultant neurosurgeon and Head of Surgical Neurology at the University of Dundee. Professor Matthews and Mr Eljamel run the Dundee Neurosurgery for Mental Disorder service, and both participate in the Cyberonics®-funded D03 trial of vagus nerve stimulation.

The authors review contemporary indications for neurosurgical interventions in the management of chronic and refractory mental disorder, the procedures involved, their efficacy and known adverse effects. These data are presented within the context of a brief historical overview of the use of neurosurgery for mental disorder. In addition to a consideration of neurosurgical procedures that rely on the creation of putative therapeutic lesions, we also review two novel, non-destructive neurosurgical electrostimulation treatments that may represent viable alternatives to conventional ablative neurosurgery: vagus nerve stimulation and deep brain stimulation.