Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: NPD transient NPSE: 0.94-11.50%; permanent NPSE: 0.94-2.03%

• Primary Outcome: Frequency of transient and permanent neuropsychological side effects

• Nnt Or Sensitivity: Comparable safety profile to conventional neurosurgical procedures across most cognitive domains

• Confidence Interval: Not reported in abstract

Clinical Application

Findings support broader consideration of psychiatric neurosurgery given comparable safety profile to accepted procedures Relevant to Australian neurosurgical centres offering psychiatric neurosurgery; may inform TGA device approvals and RANZCP position statements on neurosurgery for mental disorders Patients with treatment-resistant psychiatric disorders being considered for neurosurgical intervention

Abstract

BACKGROUND: Psychiatric disorders are increasingly contributing to global disability. Despite advances in conservative management, the prevalence of treatment-resistant cases remains high. Meanwhile, neurosurgery for psychiatric disorders (NPD) remains underused, largely due to strict regulations and historical concerns, particularly those related to neuropsychological side effects (NPSE). OBJECTIVE: To address this issue, we conducted a systematic review with meta-analysis to compare NPSE associated with radiofrequency ablative NPD to those observed in neuro-oncological, neurovascular and epilepsy surgeries. METHODS: PubMed, Embase and LILACS databases were searched in April 2024 for articles published in English/Spanish from 1990 to 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: A total of 48 articles with 2678 participants were included. The frequency of transient and permanent NPSE in the NPD group ranged from 0.94% to 11.50% and 0.94% to 2.03%, respectively, comparable to the other surgical groups (epilepsy: 0.31-11.70%; vascular: 0.52-22.90%; oncology: 0.94-17.60% for transient NPSE; epilepsy: 0.31-12%; vascular: 0.40-1.96% and oncology: 0.84-1.48% for permanent NPSE). Regarding permanent NPSE, arguably the most critical consideration, the NPD group showed better outcomes in memory, language and social cognition than the epilepsy group, but worse outcomes in executive and perceptual-motor functions. Compared with the vascular group, the NPD group had better executive function but worse complex attention. Finally, the NPD group had fewer permanent deficits than the oncology group in executive function, complex attention and perceptual-motor domains, although language performance was lower. CONCLUSIONS: Contemporary NPD apparently carries a similar risk of NPSE as other conventional neurosurgical procedures, challenging misconceptions and this unjustified barrier to its broader use.

References

1. 1.Vilela-Filho, O., Bannach, M. A., Lino-Filho, A. M., Hamani, C., Nuttin, B., Hariz, M., Schulder, M., Greenberg, B. D., Cosgrove, R., De Oliveira-Souza, R., Horn, A., Sheth, S. A., Kubu, C., Salem, S., Zaccariotti, A. J., Tavares, N. O., Damasceno, B. P., Mayberg, H. S., Lozano, A. M., Visser-Vandewalle, V., Kuhn, J., Falkai, P., Slavin, K., Doshi, P., Lopes, A. C., Vattimo, E. F., Coyne, T., Akram, H., Toda, H., ... Gonçalves-Ferreira, A. (2026). Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: Systematic review and meta-analysis. *Journal of Neurology, Neurosurgery, and Psychiatry*. https://doi.org/10.1136/jnnp-2025-337800