The Impact of Surgical Frontolimbic Disconnection on Delusions and Hallucinations

Background: Apparently, delusional/hallucinatory symptoms, hallmarkers of the psychotic disorders, are not amenable to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or associated with anterior cingulotomy. No improvement of hallucinations and delusions was noted in any of these patients. To improve the control of aggression, subcaudate tractotomy was added to the previous surgical protocol.

Objective: To investigate the impact of this modified surgical approach on delusions and hallucinations.

Methods: Retrospective analysis of the medical records of psychotic patients presenting with treatment-resistant aggressiveness, delusions and hallucinations submitted to bilateral subcaudate tractotomy + bilateral anterior cingulotomy + bilateral amygdalotomy in our institution.

Results: Five patients (three schizophrenics), all male, with ages ranging from 25 to 65 years, followed-up by a mean of 45.6 months (17–72 months), fulfilled the inclusion criteria. Delusions and hallucinations were abolished in four of them.

Conclusions: These results suggest that the key element for relieving these symptoms was the subcaudate tractotomy and that the orbitofrontal and ventromedial frontal cortices play an important role in the genesis of hallucinatory and delusional symptoms of schizophrenia and other psychoses.