Evolving Perspectives in Psychosurgery: A Comprehensive Analysis from Lobotomy to Connectomics
By
Victor González
Jordi Rumià
Marta Brell
Carolina Roset
José de Miguel
Susana Arboleya
Iratxe Aguirre
Daniel Alegre
Victor Goliney
Javier Ibáñez
April 23, 2026
Clinical Scorecard: Evolving Perspectives in Psychosurgery: A Comprehensive Analysis from Lobotomy to Connectomics
At a Glance
Category Detail
Condition Severe and treatment-resistant psychiatric disorders Key Mechanisms Circuit-based medicine focusing on fronto-limbic networks and connectomics Target Population Carefully selected subgroups of treatment-refractory patients Care Setting Multimodal approach including neurosurgery, psychotherapy, and psychosocial rehabilitation
Key Highlights
Shift from broad lesions to targeted interventions within brain circuits Integration of modern imaging techniques for precise targeting Emphasis on symptom dimensions over categorical diagnoses Use of both ablative and stimulation-based interventions Focus on ethical and organizational challenges in psychosurgery Guideline-Based Recommendations
Diagnosis
Focus on symptom clusters rather than DSM categorical diagnoses Management
Utilize a multimodal approach including candidate selection and interdisciplinary discussion Monitoring & Follow-up
Long-term follow-up with device programming and psychosocial rehabilitation Risks
Consideration of ethical implications and potential stigma associated with psychosurgery Patient & Prescribing Data
Patients with severe and persistent psychiatric disorders, particularly those with treatment-resistant symptoms
Ablative procedures and deep brain stimulation are clinically meaningful interventions
Clinical Best Practices
Employ connectivity-based planning for surgical interventions Integrate psychotherapeutic and pharmacological strategies with neuromodulation Prioritize evidence from landmark trials and high-quality observational studies References
