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 four types of NMD technique:

Subcaudate tractotomy: In this procedure, 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.
Anterior capsulotomy: In this procedure, 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.
Anterior cingulotomy: This procedure involves a similar technique to anterior capsulotomy, but targets an area of your brain called the anterior cingulate gyrus.
Limbic leucotomy: This procedure is a combination of anterior cirgulotomy and subcaudate tractotomy.

There is little agreement amongst researchers and health professionals as to which of these techniques is the most effective.

The technique that you receive will depend on where you are treated as different treatment centres are likely to use different techniques. All of these techniques are irreversible.

About the procedure

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

Your hair is shaved in small areas on your scalp where the surgery will be performed.
You are given a general or a local anaesthetic, depending on the NMD technique being used.
A special apparatus called a stereotactic frame is attached to your skull through tiny cuts in your scalp. The frame is used to hold the surgical tools in place. ('Stereotactic' means that the tools can be guided precisely in three dimensions, so that the surgery can be very exact.)
A small hole is made in your skull using a special drill.
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 area within your brain.
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.
The probe and the frame are then removed, and the cuts in your scalp are stitched and/or glued.

How soon will I recover after the operation?

Recovery is a slow process, so you'll need to take your rehabilitation gradually in the following weeks and months. Most people are able to tell if the treatment is working and see changes in their mood within the first 9 – 12 months.

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