Neurosurgery for mental disorder (NMD)

Explains what NMD is, what the operation is like, possible side effects and alternative surgical treatments. Also covers the law around consent to treatment by NMD.

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What happens in the operation?

There are three NMD techniques currently used in the UK:

NMD technique

What it means

Subcaudate tractotomy

Two probes are inserted via small holes made in your forehead, and guided to a part of your brain called the caudate nucleus. A very small part of this target area is then destroyed using an electrical current.

Bilateral anterior capsulotomy

Two probes are passed via incisions on each side of the midline on the top of your head into a part of the brain called the internal capsule, which is close to the caudate nucleus. A very small part of this target area is then destroyed using an electrical current.

Bilateral anterior cingulotomy

This procedure involves a similar technique to bilateral anterior capsulotomy, but targets an area of your brain called the anterior cingulate gyrus.

There is no international agreement on which of these techniques is the best way of performing NMD, and different techniques are used at different treatment centres.

About the procedure

Regardless of which specific NMD technique is being performed, the operation itself is likely to follow this procedure:

  1. Your hair is shaved in small areas on your scalp where the surgery will be performed.
  2. You are given a general anaesthetic, so you are unconscious during the operation.
  3. A special apparatus called a stereotactic frame is attached to your skull through tiny cuts in your scalp, using skin folds wherever possible. The purpose of this frame is to hold the delicate surgical tools in place. ('Stereotactic' means that the tools can be guided precisely in three dimensions, so that the surgery can be very exact.)
  4. A small hole (called a burr hole), is made in your skull using a special drill.
  5. A very fine probe is put through this hole. Computer software is used alongside brain imaging technology, such as magnetic resonance imaging (MRI) scanning, to guide the probe precisely to the target spot within your brain (to an accuracy of one millimetre).
  6. When the probe is in the right place, an electrical current is passed through it. This generates heat to destroy a very small area of brain tissue at the end of the probe.
  7. The probe and the frame are then removed, and the cuts in your scalp are stitched and/or glued.

The operation usually takes about 90 minutes, most of which is taken up by scans to monitor the position of the probe.

How soon will I recover after the operation?

Two days after the operation you should be able to sit out of bed; on the third day, you should be able to start moving about. But recovery is a slow process, so you'll need to take your rehabilitation gradually in the following weeks and months.

It's important to remember that NMD alone is not a cure for severe depression or OCD, but it could help lift your symptoms so that you are able to benefit from other forms of treatment, such as talking treatments.

This information was published in May 2015. We will revise it in 2018.

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