While the mechanism by which lesions produce their clinical effects remains unclear, it is likely that brain neurochemistry and neuroendocrine parameters should change as a result of surgery. Changes in these indices have been investigated in relation to stereotactic subcaudate tractotomy and are comprehensively reviewed elsewhere.(3.) The limitations of these studies are either due to the lack of healthy controls (applicable to studies of central cerebrospinal fluid and brain tissue) or to the common problem of relating peripheral chemical indices with changes in brain function. The most notable findings from these studies are a decrease in 5-HT 1A

binding in the superficial layer of the cortex of depressed patients when compared with surgical controls, (38) and an association between the extent of decreased urinary noradrenaline (norepinephrine)output 2 weeks postoperatively and outcome as measured at 6 months. (39)

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