Recent developments in neuroscience have inspired proposals to perform deep brain stimulation on psychopathic detainees. We contend that these proposals cannot meet important ethical requirements that hold for both medical research and therapy. After providing a rough overview of key aspects of psychopathy and the prospects of tackling this condition via deep brain stimulation, we proceed to an ethical assessment of such measures, referring closely to the distinctive features of psychopathic personality, particularly the absence of subjective suffering and a lack (...) of moral motivation. Scrutiny of these factors reveals that two essential bioethical criteria, individual medical benefit and voluntary informed consent, cannot be met in performing neurosurgical experiments or treatments on psychopathic inmates. (shrink)

I argue that deep brain stimulation (DBS) is a bad approach for incarcerated psychopaths for two reasons. First, given what we know about psychopathy, empathy, and DBS, it is unlikely to function as an effective treatment for the moral problems that characterize psychopathy. Second, considerations of neurodiversity speak against seeing psychopathy as a mental illness in the first place.

Growing interest in psychiatric neurosurgery, and in deep brain stimulation (DBS) in particular, requires that the field be placed in the appropriate historical and scientific context. Current methods of neuromodulation for refractory psychiatric conditions are premised on assumptions similar to those proposed in earlier attempts, namely, the number of resistant patients and the absence of any other effective treatments. As a result, a discussion of the current and future prospects, as well as the limits, of neuromodulation is required to (...) avoid a replay of earlier transgressions, and to place its current chapter in the appropriate historical and ethical context. (shrink)

For a few decades, patients with Parkinson's disease have been treated with intracerebral transplantations of fetal mesencephalic tissue. The results of open trials have been variable. Double blind, placebo-controlled studies have recently been started in order to further investigate the efficacy of this new medical technique. In this paper we challenge the need for sham surgery in neurotransplantation research on PD patients. Considerations regarding the research subjects' informed consent, therapeutic misconception, the integrity of the human body, and the assessment of (...) risks and benefits argue against sham surgery for patients with PD. Moreover, there is an alternative, less harmful mode of research that can provide the same or comparable scientific evidence. A plea is made for intrapatient research based on quantitative measurements of the patient's pre- and post-operative condition combined with similar research on a reference group of patients who have received the standard treatment. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and (...) to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Recent developments in the field of neurosurgery, specifically those dealing with the modification of mood and affect as part of psychiatric disease, have led some researchers to discuss the ethical implications of surgery to alter personality and personal identity. As knowledge and technology advance, discussions of surgery to alter undesirable traits, or possibly the enhancement of normal traits, will play an increasingly larger role in the ethical literature. So far, identity and enhancement have yet to be explored in a (...) neurosurgical context, despite the fact that 1) neurological disease and treatment both potentially alter identity, and 2) that neurosurgeons will likely be the purveyors of future enhancement implantable technology. Here, we use interviews with neurosurgical patients to shed light on the ethical issues and challenges that surround identity and enhancement in neurosurgery. The results provide insight into how patients approach their identity prior to potentially identity-altering procedures and what future ethical challenges lay ahead for clinicians and researchers in the field of neurotherapeutics. (shrink)

BackgroundPsychiatric neurosurgery is experiencing a revival. Beside deep brain stimulation, several ablative neurosurgical procedures are currently in use. Each approach has a different profile of advantages and disadvantages. However, many psychiatrists, ethicists, and laypeople are sceptical about psychiatric neurosurgery.MethodsWe identify the main concerns against psychiatric neurosurgery, and discuss the extent to which they are justified and how they might be overcome. We review the evidence for the effectiveness, efficacy and safety of each approach, and discuss how this (...) could be improved. We analyse whether and, if so, how randomised controlled trials can be used in the different approaches, and what alternatives are available if conducting RCTs is impossible for practical or ethical reasons. Specifically, we analyse the problem of failed RCTs after promising open-label studies.ResultsThe main concerns are: reservations based on historical psychosurgery, concerns about personality changes, concerns regarding localised interventions, and scepticism due to the lack of scientific evidence. Given the need for effective therapies for treatment-refractory psychiatric disorders and preliminary evidence for the effectiveness of psychiatric neurosurgery, further research is warranted and necessary. Since psychiatric neurosurgery has the potential to modify personality traits, it should be held to the highest ethical and scientific standards.ConclusionsPsychiatric neurosurgery procedures with preliminary evidence for efficacy and an acceptable risk–benefit profile include DBS and micro- or radiosurgical anterior capsulotomy for intractable obsessive–compulsive disorder. These methods may be considered for individual treatment attempts, but multi-centre RCTs are necessary to provide reliable evidence. (shrink)

Objective: Although a main principle of medical ethics and law since the 1970s, standards of informed consent are regarded with great scepticism by many clinicans.Methods: By reviewing the reactions to and adoption of this principle of medical ethics in neurosurgery, the characteristic conflicts that emerge between theory and everyday clinical experience are emphasised and a modified conception of informed consent is proposed.Results: The adoption and debate of informed consent in neurosurgery took place in two steps. Firstly, respect for (...) patient autonomy was included into the ethical codes of the professional organisations. Secondly, the legal demands of the principle were questioned by clinicians. Informed consent is mainly interpreted in terms of freedom from interference and absolute autonomy. It lacks a constructive notion of physician–patient interaction in its effort to promote the best interest of the patient, which, however, potentially emerges from a reconsideration of the principle of beneficence.Conclusion: To avoid insufficient legal interpretations, informed consent should be understood in terms of autonomy and beneficence. A continuous interaction between the patient and the given physician is considered as an essential prerequisite for the realisation of the standards of informed consent. (shrink)

Neurosurgeons have an especially high rate of exposure to serious ethical challenges in their line of work. The aim of this study was to assess the type and frequency of ethical theories used by neurosurgery residents to make extra- ethical decisions in challenging situations and their relation with the level of residency, and curricular training about medical ethics. A total of 12 neurosurgery residents in Mashhad University of Medical Sciences were interviewed; all the participants were male and aged (...) 29–40 years old. Of all, six were senior and six were junior. Using a systematic review of neurosurgery and medical ethics textbooks, five common cases were selected and a semi-structured, open-ended interview was developed. The interviews were digitally recorded and analyzed in two separate stages. Comparison of the results of the two stages led us to the final judgment about the dominant ethical theory used in each case. In all 60 cases, the decision-making process was compatible with either Deontology or Consequentialism. Only in two cases, beside Deontology, the Virtue ethics was used as an alternative in special situations. The ethical theories were not consistent for all the 12 subjects and all the five questions. No statistically significant difference was found between senior and junior residents, neither for each question nor for the aggregate. Only one of the subjects had extracurricular training in medical ethics, consequently precluding further analysis. Although not intended to be evaluated by this study, similar heterogeneity was observed in final decisions. When faced with medical ethics challenges, neurosurgery residents did not follow a consistent ethical theory for making decisions. The type and frequency of theories did not seem to be changed during the residency period. (shrink)

Moral Enhancement wird von einer Reihe einflussreicher Bioethiker propagiert, zum Teil mit dem Anspruch, dass nur dadurch die Menschheit vor ihrem selbstverschuldeten Untergang zu retten sei. Nachdem begründete Zweifel an der Eignung der zum Moral Enhancement vorgeschlagenen Psychopharmaka aufgekommen sind, wurden neurochirurgische Interventionen, insbesondere die Tiefe Hirnstimulation, vorgeschlagen. Diese Ad-hoc-Vorschläge stützen sich auf eine Handvoll neurochirurgischer Eingriffe an geistig schwer behinderten Menschen sowie die Psychochirurgie des letzten Jahrhunderts. In diesem Aufsatz geht es erstens um die Frage, ob Moral Enhancement durch (...) neurochirurgische Methoden überhaupt möglich ist und, wenn ja, inwiefern, und zweitens um die Frage nach dessen ethischer Vertretbarkeit, sofern es möglich ist. Mit den bisher vorgeschlagenen Methoden des neurochirurgischen Moral Enhancement könnte man zwar Aggressionen oder den Sexualtrieb reduzieren, sodass weniger Selbstkontrolle erforderlich wäre, um moralisch angemessen zu handeln. Theoretisch denkbar, aber bisher nicht durch empirische Evidenz gestützt, ist, dass neurochirurgische Eingriffe die Selbstkontrolle verbessern könnten. Nach dem Modell der moralischen Intelligenz von Carmen Tanner und Markus Christen lässt sich zeigen, dass dadurch allenfalls eine Komponente der moralischen Intelligenz verbessert werden könnte, nämlich die moralische Standhaftigkeit. Keiner der bisherigen Vorschläge zielt dagegen auf die Verbesserung der anderen vier Komponenten, also des moralischen Kompasses, der moralischen Sensibilität, der moralischen Urteilsfähigkeit und der moralischen Motivation. Ein umfassendes Moral Enhancement durch neurochirurgische Eingriffe ist mit den gegenwärtig verfügbaren oder vorgeschlagenen Methoden also nicht möglich. Allenfalls lässt sich in Zukunft durch Closed-Loop-Systeme, die bestimmte Impulse automatisch herunter regeln, ein moralkonformeres Verhalten erreichen. Eine nur technisch induzierte Verhaltensverbesserung wäre allerdings höchstens unter Zugrundelegung eines utilitaristischen Moralverständnisses als moralische Verbesserung anzuerkennen. (shrink)

Do neurosurgical procedures ever result in the patient prior to the procedure not being identical with the individual who wakes up postsurgery in the hospital bed? We address this question by offering an analysis of the persistence of persons that emphasizes narrative, rather than numerical, identity. We argue that a narrative analysis carries the advantage of highlighting what matters to patients in their ordinary lives, explaining the varying degrees of persistence of personal identity, and enhancing our understanding of patients' experiences. (...) We illustrate these points in cases involving temporal lobectomy for treatment of refractory epilepsy and deep brain stimulation for refractory Parkinson's disease. (shrink)

Multidisciplinary healthcare committees meet regularly to discuss patients’ candidacy for emerging functional neurosurgical procedures, such as Deep Brain Stimulation . Through debate and discussion around the surgical candidacy of particular patients, functional neurosurgery programs begin to mold practice and policy supported both by scientific evidence and clear value choices. These neurosurgical decisions have special considerations not found in non-neurologic committees. The professional time used to resolve these conflicts provides opportunities for the emergence of careful, ethical practices simultaneous with the (...) expansion of therapy applications. (shrink)

Stereotactic neurosurgery emerged in the mid-20th century following the development of a stereotactic frame by Spiegel and Wycis. Historically women were underrepresented in clinical and academic neurosurgery. There is still a significant deficit of female scientists in this field. This article aims to demonstrate the career and scientific work of some of the most important women who contributed to the development of stereotactic and functional neurosurgery. Exceptional women from all over the world, represented in this review, assisted (...) the evolution of modern stereotactic and functional neurosurgery as neurosurgeons, neuropathologists, neurologists, neurophysiologists and occupational therapists. Fortunately, we could conclude that in the last two decades the number of female researchers has increased significantly. (shrink)

Treatment of diseases of the brain by drugs or surgery necessitates an understanding of its structure and functions. The philosophical neurosurgeon soon encounters difficulties when localising the abstract concepts of mind and soul within the tangible 1300-gram organ containing 100 billion neurones. Hippocrates had focused attention on the brain as the seat of the mind. The tabula rasa postulated by Aristotle cannot be localised to a particular part of the brain with the confidence that we can localise spoken speech to (...) Broca's area or the movement of limbs to the contralateral motor cortex. Galen's localisation of imagination, reasoning, judgement and memory in the cerebral ventricles collapsed once it was evident that the functional units-neurones-lay in the parenchyma of the brain. Experiences gained from accidental injuries (Phineas Gage) or temporal lobe resection (William Beecher Scoville); studies on how we see and hear and more recent data from functional magnetic resonance studies have made us aware of the extensive network of neurones in the cerebral hemispheres that subserve the functions of the mind. The soul or atman, credited with the ability to enliven the body, was located by ancient anatomists and philosophers in the lungs or heart, in the pineal gland (Descartes), and generally in the brain. When the deeper parts of the brain came within the reach of neurosurgeons, the brainstem proved exceptionally delicate and vulnerable. The concept of brain death after irreversible damage to it has made all of us aware of 'the cocktail of brain soup and spark' in the brainstem so necessary for life. If there be a soul in each of us, surely, it is enshrined here. (shrink)

Fundamento. La historia de la Neurocirugía en el territorio está estrechamente relacionada con la de otras especialidades como la Cirugía General y la Ortopedia. Tiene sus primeras referencias establecidas en la etapa colonial en el Hospital General, documentadas en el Boletín del Colegio Médico de Camagüey. Objetivo es resaltar la importancia que tuvieron el Hospital General y el Colegio Médico de Camagüey con su boletín en la historia de la Neurocirugía y la Ortopedia. Método. Es una investigación histórica que se (...) basa en la revisión documental y utiliza el submétodo cronológico para establecer el orden de los hechos que se describen. Desarrollo. El Hospital General a partir de su reconstrucción a finales del siglo XIX, se convirtió en el principal centro médico quirúrgico de la provincia en la época colonial. Muchos de los resultados de la actividad asistencial y científica de sus médicos apareció publicada en el Boletín del Colegio Médico de Camagüey, prestigiosa revista científica que se encargó de divulgar los resultados de la medicina camagüeyana y donde aparecen artículos que evidencian cómo cirujanos generales realizaron las primeras intervenciones neuroquirúrgicas y ortopédicas. Conclusiones. Se consideran al Hospital General y al Colegio Médico de Camagüey y su boletín, como elementos indispensables al escribir la historiografía de la Neurocirugía y la Ortopedia en el territorio. Ground: the history of Neurosurgery in this place is closely linked to other specialties like General Surgery and Orthopedics. The first documented references went back to the colonial period in the General Hospital, documented in the bulletin of the medical college in Camagüey. The objective is to highlight the importance of the General Hospital and the medical college and its bulletin in the history of Neurosurgery and Orthopedics in Camagüey. Methods: This a historical investigation that was carried out taking documented revision and using chronologic sub method to establish the order of the facts that have been described. Development: Since the reconstruction of the General hospital at the end of the XIX century, it became the main medical_ surgical center in the province during the colonial period. Many of the scientific results and medical activities were published in the bulletin of the medical college, which became a well-known scientific magazine that was in charge of publishing the medical success in Camagüey. There are articles to prove that general surgeons performed the first neurosurgical and orthopedic interventions. Conclusions: The General hospital, the medical college and its bulletin are considered crucial elements to describe the history of Neurosurgery and Orthopedics in the territory. (shrink)

Müller and colleagues (2015) address a range of ethical considerations associated with neurosurgical interventions for the treatment of anorexia nervosa (AN), arguing for several protective measures to safeguard clinical research and practice. This is an important article, which provides a thorough review of current neurosurgical research and presents key insights into challenges associated with compromised decision-making capacities in the context of AN and the early average age of onset. However, it is somewhat striking that they neither use nor examine the (...) concept of authenticity. We describe the way this concept features in discussions of AN, and suggest that a deeper understanding of authenticity reveals further ethical problems that Müller and colleagues do not consider. (shrink)

Se realizó una revisión bibliográfica con el objetivo de valorar las implicaciones sociales de la investigación científico-tecnológica en Neurosicología del Adulto Mayor, mediante la caracterización del estado actual del proceso, los condicionantes que favorecen o impiden su desarrollo y los impactos sociales que genera. La investigación científico-tecnológica en esta área está condicionada por necesidades sociales propias del contexto actual. Se han identificado políticas, legislaciones e infraestructuras que la favorecen, aunque, existen algunas limitaciones. La producción tecnológica dirigida a la rehabilitación y (...) estimulación cognitiva continúa en ascenso, utilizando principalmente software y aplicaciones. La investigación del impacto de estas herramientas ha arrojado resultados contradictorios, lo que limita su poder de transformación social. Se pudo concluir que en Cuba es necesario estimular la transferencia de tecnología, la innovación tecnológica y la creación de alternativas de intervención ajustadas a la realidad económico-social de los adultos mayores. A bibliographical review was conducted with the aim of assessing the social implications of scientific-technological research in Senior Citizens' Neurosurgery through the characterization of the current state of the process, the determining factors that favor or stop its development and the social impact it generates. In this field, scientific-technological research is conditioned on social necessities typical of the current context. Policies, legislations and the infrastructures that favor it have been identified. Nevertheless, there are limitations. Technological production directed towards cognitive rehabilitation and stimulation continues to rise using mainly software and applications. The research on the impact of these tools has produced contradictory results, which limit their social transformation power. It was reached the conclusion that in Cuba, there's a need to stimulate technology transfer, technological innovation and the creation of intervention alternatives adapted to senior citizens' social-economic reality. (shrink)

Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also (...) to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence. The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded. The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group. (shrink)

Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique logistical needs of delivering operative care, surgical missions are often described solely in terms of cases performed, with a paucity of discourse on medical ethics. Within surgery, subspecialties that serve patients on a non-elective basis should, it could be argued, create mission strategies that involve a didactic approach and the propagation (...) of sustainable surgical care. The ethical considerations have yet to be described for paediatric neurosurgical outreach missions. We present here the perspectives of neurosurgeons who have participated in surgical outreach missions in Central America, South America, Eastern Europe and sub-Saharan Africa from the vantage point of both the visiting mission team and the host team that accommodates the mission efforts. (shrink)

Volume 20, Issue 7, July 2020, Page 196-198.

Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal identity (...) have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for “diagnosing” the supposed changes in “identity” are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism.We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies.We recommend a pragmatic approach: empirical research on personality changes arising from brain disorders or interventions, comprehensive information about risks of personality changes, and advance directives, particularly Ulysses contracts. (shrink)

Using fMRI, we investigated how right temporal lobe gliomas affecting the posterior superior temporal sulcus alter neural processing observed during speech perception and production tasks. Behavioural language testing showed that three pre-operative neurosurgical patients with grade 2, grade 3 or grade 4 tumours had the same pattern of mild language impairment in the domains of object naming and written word comprehension. When matching heard words for semantic relatedness (a speech perception task), these patients showed under-activation in the tumour infiltrated right (...) superior temporal lobe compared to 61 neurotypical participants and 16 patients with tumours that preserved the right postero-superior temporal lobe, with enhanced activation within the (tumour-free) contralateral left superior temporal lobe. In contrast, when correctly naming objects (a speech production task), the patients with right postero-superior temporal lobe tumours showed higher activation than both control groups in the same right postero-superior temporal lobe region that was under-activated during auditory semantic matching. The task dependent pattern of under-activation during the auditory speech task and over-activation during object naming was also observed in eight stroke patients with right hemisphere infarcts that affected the right postero-superior temporal lobe compared to eight stroke patients with right hemisphere infarcts that spared it. These task-specific and site-specific cross-pathology effects highlight the importance of the right temporal lobe for language processing and motivate further study of how right temporal lobe tumours affect language performance and neural reorganisation. These findings may have important implications for surgical management of these patients, as knowledge of the regions showing functional reorganisation may help to avoid their inadvertent damage during neurosurgery. (shrink)

Growing interest in psychiatric neurosurgery, and in deep brain stimulation (DBS) in particular, requires that the field be placed in the appropriate historical and scientific context. Current methods of neuromodulation for refractory psychiatric conditions are premised on assumptions similar to those proposed in earlier attempts, namely, the number of resistant patients and the absence of any other effective treatments. As a result, a discussion of the current and future prospects, as well as the limits, of neuromodulation is required to (...) avoid a replay of earlier transgressions, and to place its current chapter in the appropriate historical and ethical context. (shrink)

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more (...) animal research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a cure of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction. (shrink)

BackgroundDiagnostic ultrasound has long been a part of a physician’s armamentarium, but transcranial focused ultrasound (FUS) is an emerging treatment of neurological disorders. Consequently, the literature in this field is increasing at a rapid pace.ObjectiveThis analysis was aimed to identify the top-cited articles on FUS to discern their origin, spread, current trends highlighting future impact of this novel neurosurgical intervention.MethodsWe searched the Web of Science database on 28th May 2021 and identified the top 100 cited articles. These articles were analyzed (...) with various scientometric parameters like the authors, corresponding authors, country of corresponding author, journal of publication, year of publication. Citation based parameters including total citations, mean citations per article and mean citations, citation count, and the citation per year, citations per year and co-authors per document were studied as well in addition to Hirsch h-index, g-index, m-index, Bradford’s Law, Lotka’s law and Collaboration index.ResultsThe 100 top-cited articles were published between 1998 and 2019 in 45 different journals. The average citations per document and citations per document per year were 97.78 and 12.47, respectively. The most prolific authors were Hynynen K (Medical Biophysics—Toronto), Elias WJ (Neurosurgery—Virginia), Zadicario (InSightec). The Journal of Neurosurgery published the most top-cited articles (n = 11), and most articles originated from the United States, followed by Canada. Among individual institutions, the University of Toronto was the most productive.ConclusionFUS is an emerging treatment of neurological disorders. With its increasing application, the FUS literature is increasing rapidly. Eleven countries contributed to the top 100 cited articles, with the top 2 countries (the United States and Canada) contributing to more than half of these articles. (shrink)