Current Ablation Type Surgical Treatment Modalities in Treatment-Resistant Major Depression: Review of The Recent Major Surgical Series

Abstract

Purpose: Major depression is currently a disease with high morbidity and mortality rates. About 20% of patients have treatment-resistant major depression (TRMD). This article which consisted of a recent large clinical case series reported in medical literature is constituted to screen ablative surgical treatment methods and their safety and efficacy in patients with TRMD. Methods: Four types of ablative surgical modality (i.e. anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy) in TRMD patients were evaluated and patients' data which was used to describe the basis of radiologic and operative procedures and findings, and outcome was obtained from PubMed/Medline database between years 2000-2018. Results: In literature, studies showed that about 40-60% of patients had complete remission and 35% of patients showed partial remission following anterior cingulotomy. It was reported that approximately 50% of patients were responsive and 40% of patients were remission following anterior capsulotomy. Studies demonstrated that about 55-75% of patients were responsive to treatment after performing subcaudate tractotomy. Long term clinical recovery was seen 36-76% of patients applied limbic leucotomy in literature. Conclusion: In conclusion, the long term therapeutic effects and mechanism of action of these surgical techniques that were used last two decades in the management of patients with TRMD are still under investigation and the need for research on the long-term benefits of these surgical modalities should be considered.