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Research paper
Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders
  1. Bart Nuttin1,2,3,4,
  2. Hemmings Wu1,
  3. Helen Mayberg3,5,
  4. Marwan Hariz4,6,
  5. Loes Gabriëls4,7,
  6. Thorsten Galert3,8,
  7. Reinhard Merkel3,9,
  8. Cynthia Kubu3,10,
  9. Osvaldo Vilela-Filho4,11,
  10. Keith Matthews4,12,
  11. Takaomi Taira13,
  12. Andres M Lozano14,
  13. Gastón Schechtmann4,15,
  14. Paresh Doshi4,16,
  15. Giovanni Broggi4,17,
  16. Jean Régis4,18,
  17. Ahmed Alkhani4,19,
  18. Bomin Sun4,20,
  19. Sam Eljamel4,21,
  20. Michael Schulder22,
  21. Michael Kaplitt23,
  22. Emad Eskandar24,
  23. Ali Rezai25,
  24. Joachim K Krauss26,
  25. Paulien Hilven27,
  26. Rick Schuurman28,
  27. Pedro Ruiz29,
  28. Jin Woo Chang4,30,
  29. Paul Cosyns31,
  30. Nir Lipsman4,32,
  31. Juergen Voges4,33,
  32. Rees Cosgrove4,34,
  33. Yongjie Li35,
  34. Thomas Schlaepfer3,36
  1. 1Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium
  2. 2Chair of Committee of Neurosurgery for Psychiatric Disorders of the WSSFN and Department of Neurosurgery, UZ Leuven, Leuven, Belgium
  3. 3Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship.
  4. 4WSSFN Committee on Neurosurgery for Psychiatric Disorders
  5. 5Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
  6. 6Department of Clinical Neuroscience, UCL Institute of Neurology, Queen Square, London, Umea University, Umea, Sweden
  7. 7Chair of the Committee of Neurosurgery for Psychiatric Disorders, Belgium and Belgium and Department of Psychiatry, UZ Leuven, Leuven, Belgium
  8. 8Deutsches Referenzzentrum für Ethik in den Biowissenschaften, Bonn, Germany
  9. 9Universität Hamburg/Juristische Fakultät Lehrstuhl für Strafrecht und Rechtsphilosophie, Hamburg, Germany
  10. 10Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
  11. 11Department of Neurosciences, Institute of Neurology of Goiânia, Stereotactic and Functional Neurosurgery Service, Medical School, Federal University of Goiás, Medical School, Pontifical Catholic University of Goiás, Goiânia, Brazil
  12. 12Advanced Interventions Service and Division of Neuroscience, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
  13. 13Past-president of WSSFN and Chair of Committee of Stereotactic and Functional Neurosurgery, World Federation of Neurosurgical Societies (WFNS), and Department of Neurosurgery, World Federation of Neurosurgical Societies (WFNS), Tokyo Women's Medical University, Tokyo, Japan
  14. 14Past-president of WSSFN and Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
  15. 15Department of Neurosurgery and Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden
  16. 16Stereotactic and Functional Neurosurgery Program, Jaslok Hospital and Research Centre, Mumbai, India
  17. 17Department of Neurosurgery, Instituto Neurologico C. Besta, Milano, Italy
  18. 18Department of Functional Neurosurgery, Hôpital La Timone, Aix-Marseille Université, Marseille, France
  19. 19Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, AlFaisal University, Riyadh, Saudi Arabia
  20. 20Center for Functional Neurosurgery, Shanghai Jiao Tong University Rui Jin Hospital, Shanghai, China
  21. 21Centre of Neurosciences Department of Neurosurgery, Ninewells Hospital and Medical School Dundee, Dundee, Scotland, UK
  22. 22Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USA
  23. 23Member of the Psychiatric Surgery Committee of the ASSFN and Department of Neurological Surgery, Weill Cornell Medical College, NY, USA
  24. 24Member of the Psychiatric Surgery Committee of the ASSFN and Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  25. 25Past President, American Society of Stereotactic and Functional Neurosurgery (ASSFN), Department of Neurosurgery, American Society of Stereotactic and Functional Neurosurgery (ASSFN), Ohio State University, Ohio, USA
  26. 26President of ESSFN and WSSFN, Department of Neurosurgery, Medical University of Hannover, Hannover, Germany
  27. 27KU Leuven, Belgium
  28. 28Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
  29. 29President of WPA, Department of Psychiatry and Behavioral Sciences, Miami Miller School of Medicine, Miami, USA
  30. 30President of Asian Australasian Society for Stereotactic & Functional Neurosurgery Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
  31. 31Committee of Neurosurgery for Psychiatric Disorders, Belgium, Kortenberg, Belgium
  32. 32Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
  33. 33Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg and Leibniz-Institute for Neurobiology, Magdeburg, Germany
  34. 34Department of Neurosurgery, Brown University, Providence, RI, USA
  35. 35Department of Neurosurgery, Xuanwu Hospital, Beijing, China
  36. 36Chair of the Focus Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’, Chair of the Task Force on Brain Stimulation of the World Federations of Societies of Biological Psychiatry, Chair of the Section of Experimental Brain Stimulation Methods of the German Association of Psychiatry, Psychotherapy and Psychosomatics and member of the Operational Committee on Sections of the World Psychiatric Association. He is professor of Psychiatry and Psychotherapy at the University of Bonn, Germany, and Associate Professor of Psychiatry and Mental Health at The Johns Hopkins University, Baltimore, MD, USA.
  1. Correspondence to Dr Bart Nuttin, Department of Neurosurgery, UZ Leuven, KU Leuven, Herestraat 49, 3000 Leuven Belgium; bart.nuttin{at}


Background For patients with psychiatric illnesses remaining refractory to ‘standard’ therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups.

Methods To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments.

Findings The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered ‘established’ in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients.

Interpretation This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety.


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