The role of stereotactic neurosurgery as a symptomatic treatment for autism spectrum disorders: a systematic review

Abstract Although stereotactic neurosurgery has been applied in autism spectrum disorders (ASD), its safety and efficacy remain elusive due to the limited sample size. We aimed to investigate the safety and efficacy of stereotactic neurosurgery for ASD by systematically reviewing the literature through the PubMed, EMBASE and Cochrane databases. A total of 11 studies with 36 patients were included. 16 patients (44.44%) received deep brain stimulation (DBS), 10 patients (27.78%) underwent radiofrequency ablation (RA), and 10 patients (27.78%) underwent gamma knife radiosurgery and RA. The therapeutic targets of 11 patients (42.31%) were the amygdala, and the surgical indication of 10 patients was aggression; the ventral anterior limb of the internal capsule or medial forebrain bundle was regarded as the target for 6 patients (23.08%), and the surgical indication was OCD. The mean Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) score of 19 patients was 31.37 at baseline. After a median follow-up time of 48 months, the mean Y-BOCS score decreased to 18.32, and the mean improvement rate was 42.74%. After a median follow-up duration of 48 months (range: 2-120), the mean Overt Aggression Scale score of 15 patients was reduced from 11.20 to 4.40, and the mean improvement rate was 59.59%. There were a total of 8 patients whose cardinal symptoms benefited from the surgery. Seven patients (19.44%) suffered adverse events after stereotactic neurosurgery. Stereotactic neurosurgery is an effective and safe therapy to alleviate the symptoms of aggressive behaviors and OCD in ASD patients. DBS has the potential to improve the social contact difficulty and communication disorders of ASD.