This narrative review outlines a framework for contemporary psychosurgery in carefully selected patients with treatment-refractory conditions such as obsessive-compulsive disorder, major depression, eating disorders, addictions, Tourette syndrome, aggression, schizophrenia, and PTSD. It proposes connectomic-guided, circuit-based approaches, including ablative techniques (radiofrequency, radiosurgery, laser ablation, focused ultrasound) and stimulation-based interventions (deep brain stimulation, vagus nerve stimulation, cortical stimulation, transcranial magnetic stimulation).
The authors synthesize current thinking on candidate profiles and clinical outcomes, emphasizing symptom dimensions over traditional diagnostic categories. They suggest that mapping brain circuits could help tailor interventions to individual symptom patterns.
No quantitative results, effect sizes, or pooled outcomes are provided. Safety data, such as adverse events or discontinuation rates, are not reported. Because this is a narrative critical review without formal meta-analysis or primary trial data, the evidence is conceptual rather than conclusive.
Realistically, this work proposes a direction for future research and clinical planning. It does not establish efficacy or safety, and it should not guide immediate treatment decisions.