Modified Limbic Leucotomy for the Treatment of Refractory Depression

Object: The prevalence of major depression disorder is estimated at 4–10%. This condition is highly refractory to pharmacological management in long-term (30%) and, in such cases, the surgical approach is a therapeutic option. It has been recently demonstrated the relevance of the subgenual cingulum in the pathophysiology and surgical treatment of major depression disorder by means of deep brain stimulation. In the present study, the authors aimed to determine the effectiveness and safety of limbic leucotomy associated to subgenual cingulotomy (modified limbic leucotomy) for the treatment of refractory major depression disorder.

Methods: Evaluation of five patients subjected to modified limbic leucotomy in our service. Results from the Beck Depression Inventory, Beck Anxiety Inventory and the Yale-Brown Obsessive-Compulsive Scale were used to analyze the effectiveness of the procedure.

Results: The mean decrease in the Beck Depression Inventory, Beck Anxiety Inventory and Yale-Brown Obsessive-Compulsive Scale scores were 85%, 75% and 81%, respectively. Only minor and transient adverse effects were noted.

Conclusions: In spite of the minuteness of our sample, the impressive results observed pose the modified limbic leucotomy as a low risk and promising new surgical procedure for the treatment of refractory major depression disorder. These results are attributed to the interruption of the subgenual cingulum and to the broader disconnection of the ventromedial prefrontal and orbitofrontal areas achieved with this technique.

No conflict of interest has been declared by the author(s).