A Further Review of the Results of Stereotactic Subcaudate Tractotomy


Following a previous review of 210 patients who had undergone a stereotactic subcaudatc tractotomy for intractable psychiatric illnesses, the results for the next 208 patients were studied 2½-4½ years after operation.

Of the total group of 208, 134 were individually interviewed in a structured way and in every case a close relative was also seen. Twenty-five patients had died, and in one of these a major seed misplacement contributed, the only time this has happened. Forty-nine patients either could not be traced, could not be fully assessed or were unco-operative, but some details about this group were obtained.

The psychiatric background of the patients showed evidence of considerable disturbance among the whole group. In particular, suicidal attempts had been made by 12 relatives of the 78 depressives, and a further 13 had died by suicide. Paternal alcoholism occurred in 17.9 per cent of all cases. These features did not otherwise differentiate between the four main diagnostic groups—depressive illnesses, anxiety, obsessional neurosis and a group with miscellaneous diagnoses.

As many as 56.7 per cent of the 134 patients interviewed had been ill for over ten years before operation and 39.6 per cent for two to ten years. But the global clinical assessment at the time of the review showed that 58.2 per cent had recovered completely or retained only mild symptoms (I and II), 24.6 per cent were improved (III) and 17.2 per cent unchanged (IV). In no case did the operation cause worsening of the psychiatric condition (V). Of the diagnostic groups, depressives did best with 67.9 per cent in categories I and II, for anxiety this was 62.5 per cent and for obsessional neurosis 50 per cent, but of patients with other diagnoses only one improved considerably (7.1 per cent).

The validity of the clinical assessment was supported by psychological test results which were significantly different for the patients in categories I and II, compared to those in III and in IV. In addition, considerable reductions in the number of admissions to hospital, in the mean period in hospital and in the numbers of suicidal attempts were found after operation in the case of the patients of good outcome, but not for the others. Social assessments showed improvements in marital adjustment and work capacity after operation for those in categories I and II.

No socially disabling personality traits appeared, but relatives complained of some undesirable effects in 9 patients (6.7 per cent). Epilepsy requiring anticonvulsant medication occurred in 2.2 per cent.