Neurosurgical lesion procedures for psychiatric conditions have been performed for many decades, and accelerated with the addition of stereotactic neurosurgery in the mid-19th century. Lesions for movement disorders soon followed. With the advent of pharmacological treatments for these diseases, there was a decrease in the utilization of surgery. However, as the limitations of medical therapy were better recognized, there has been a resurgence of interest in neurosurgical approaches, especially over the past 20 to 30 years. While lesion surgeries were predominant in the earlier era, the advent of deep brain stimulation (DBS) over the last 20-25 years spurred a trend toward potentially ‘reversible’ neuromodulation procedures that could provide a plethora of ways to modulate the brain circuits of interest.
As the DBS and lesion data have shown comparable outcomes and side effect burden, the pendulum has been swinging back toward increased use of ablative techniques for treatment of psychiatric and movement disorders. In psychiatry, this has been due in part to the paucity of expert centers that are capable of managing DBS for psychiatric concerns, as well as the higher lifetime cost and burden of an implantable device as compared to a permanent lesion that requires minimal follow-up. In movement disorders, some of those same factors plus the availability of new tools to create potentially more accurate lesions, such as laser ablation and focused ultrasound, have renewed interest in these approaches. Thus, experienced centers now routinely balance the positive and negative factors of each approach when recommending a particular procedure for a specific patient. There is a long history of ablative techniques, primarily with a focus on radiofrequency ablation; more novel approaches have included gamma knife, laser ablation, and high intensity ultrasound.
This Research Topic explores the revitalized interest in lesion procedures, to understand best uses and future directions of ablative surgery in the context of neuromodulation more broadly.
? Clinical outcomes of novel lesion or stimulation approaches
? Neuroimaging studies (structural, functional)
? Comparisons of different approaches (including comparisons between ablation and neuro-stimulation)
? Predictors of outcome
? Modeling of lesion effects (structural and functional)
? Use of neurosurgical techniques across the lifespan
? Ethical use of these techniques
Dr. Dougherty received research support and an honorarium from Medtronic, Dr. Asaad receives research assistance via medical equipment from Medtronic External Research Program. All other Topic Editors declare no potential conflicts of interest.
Neurosurgical lesion procedures for psychiatric conditions have been performed for many decades, and accelerated with the addition of stereotactic neurosurgery in the mid-19th century. Lesions for movement disorders soon followed. With the advent of pharmacological treatments for these diseases, there was a decrease in the utilization of surgery. However, as the limitations of medical therapy were better recognized, there has been a resurgence of interest in neurosurgical approaches, especially over the past 20 to 30 years. While lesion surgeries were predominant in the earlier era, the advent of deep brain stimulation (DBS) over the last 20-25 years spurred a trend toward potentially ‘reversible’ neuromodulation procedures that could provide a plethora of ways to modulate the brain circuits of interest.
As the DBS and lesion data have shown comparable outcomes and side effect burden, the pendulum has been swinging back toward increased use of ablative techniques for treatment of psychiatric and movement disorders. In psychiatry, this has been due in part to the paucity of expert centers that are capable of managing DBS for psychiatric concerns, as well as the higher lifetime cost and burden of an implantable device as compared to a permanent lesion that requires minimal follow-up. In movement disorders, some of those same factors plus the availability of new tools to create potentially more accurate lesions, such as laser ablation and focused ultrasound, have renewed interest in these approaches. Thus, experienced centers now routinely balance the positive and negative factors of each approach when recommending a particular procedure for a specific patient. There is a long history of ablative techniques, primarily with a focus on radiofrequency ablation; more novel approaches have included gamma knife, laser ablation, and high intensity ultrasound.
This Research Topic explores the revitalized interest in lesion procedures, to understand best uses and future directions of ablative surgery in the context of neuromodulation more broadly.
? Clinical outcomes of novel lesion or stimulation approaches
? Neuroimaging studies (structural, functional)
? Comparisons of different approaches (including comparisons between ablation and neuro-stimulation)
? Predictors of outcome
? Modeling of lesion effects (structural and functional)
? Use of neurosurgical techniques across the lifespan
? Ethical use of these techniques
Dr. Dougherty received research support and an honorarium from Medtronic, Dr. Asaad receives research assistance via medical equipment from Medtronic External Research Program. All other Topic Editors declare no potential conflicts of interest.
