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The editorial cautions that enthusiasm for ablative SRS targeting the nucleus accumbens (NAc) for psychiatric disorders may be outpacing evidence. It contextualizes psychosurgical overreach history, summarizes neuroscientific and clinical risks of NAc ablation, and advocates reversible neuromodulation and strict evidence-based ethics over irreversible lesioning.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/the-perils-of-ablative-stereotactic-radiosurgery-for-the-nucleus-accumbens-a-historical-perspective-urging-caution/411898/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/the-perils-of-ablative-stereotactic-radiosurgery-for-the-nucleus-accumbens-a-historical-perspective-urging-caution/411898.png","ImageObject",300,407,{"name":42,"@type":43},"Franzy","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What concern does the editorial raise about using ablative SRS for the nucleus accumbens (NAc)?","Question",{"text":63,"@type":64},"It warns that clinical enthusiasm may be getting ahead of evidence for targeting the NAc in psychiatric disorders, risking harms associated with irreversible lesioning.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does the editorial connect current SRS proposals to past psychosurgery?",{"text":68,"@type":64},"It notes that previous psychosurgical overreach, including frontal lobotomy, helped some patients while also causing serious injuries due to the zeal of treating teams, leading to backlash and stricter oversight.",{"name":70,"@type":61,"acceptedAnswer":71},"What approach does the editorial recommend instead of irreversible NAc ablation?",{"text":72,"@type":64},"It advocates a strict, evidence-based and ethically grounded strategy that prioritizes reversible neuromodulation over irreversible 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\nSun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98236  \nOpen Access Editorial  \nThe Perils of Ablative Stereotactic Radiosurgery for the Nucleus Accumbens: A Historical Perspective Urging Caution  \nBomin Sun 1, Bart Nuttin 2, Hemmings Wu 3, Antonio De Salles 4 , Michael Schulder 5, John Adler 6  \n1. Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CHN 2. Neurosurgery, University Hospitals Leuven, Leuven, BEL 3. Neurosurgery, ZAP Surgical Systems, San Carlos, USA 4. Neurosurgery, University of California, Los Angeles, Los Angeles, USA 5. Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA 6. Radiation Oncology, ZAP Surgical Systems, San Carlos, USA  \nCorresponding author: John Adler, [jra@stanford.edu](jra@stanford.edu)  \nAbstract  \nOver the past decade, interest in lesion-based neuromodulation has experienced a resurgence fueled in large part by the noninvasive nature of new technologies, especially high-intensity focused ultrasound (HIFU) . The noninvasiveness and relatively low cost of these outpatient methods are key attributes contributing to growing acceptance. A recent resurgent embrace of stereotactic radiosurgery (SRS) for brain lesioning, especially in the treatment of tremor via thalamotomy, builds on this new trend. While we believe this development for treating well-established movement (tremor) and behavioral (obsessive-compulsive) disorders is warranted and perhaps even applauded, we are worried that enthusiasm for lesioning using SRS may now be getting ahead of itself. This concern stems from the exuberance for using SRS to treat additional behavioral diseases, as showcased during the recent American Society for Radiation Oncology (ASTRO) 2025 meeting. The near giddiness observed in San Francisco regarding the use of SRS to treat patients with psychiatric disorders prompts us to write the present cautionary editorial. The aim of this editorial is to caution against premature clinical enthusiasm for using ablative SRS to target the nucleus accumbens (NAc) for psychiatric disorders. Our objectives are to (1) contextualize this proposal within the troubling history of psychosurgical overreach, (2) summarize the substantial neuroscientific and clinical risks inherent to NAc ablation, and (3) advocate for a strict, evidence-based, and ethically grounded approach that prioritizes reversible neuromodulation over irreversible lesioning.  \nCategories: Psychiatry, Radiation Oncology, Neurosurgery  \nKeywords: accumbens, drug addiction, obsessive-compulsive disorders, psychiatric disease, stereotactic and functional neurosurgery, stereotactic radiosurgery (srs)  \nEditorial  \nInterest in lesion-based neuromodulation has surged over the past decade, propelled by the arrival of genuinely noninvasive tools like high-intensity focused ultrasound (HIFU) . The noninvasiveness and relatively low cost of these outpatient approaches have accelerated their clinical adoption. In parallel, stereotactic radiosurgery (SRS) has seen renewed enthusiasm for lesioning applications, particularly forthalamotomy in the treatment of tremor, reflecting this broader trend. Ablative SRS, a procedure that uses highly focused beams of radiation to precisely target and destroy a small, specific area within the brain, has rightly earned its place as a powerful tool in modern functional neurosurgery, offering a minimally invasive solution for selected severe, pharmacologically refractory neurological disorders [1] . Ventral intermediate nucleus (VIM) thalamotomy for essential tremor, trigeminal rhizotomy for tr","cbCaiqj6YhkukvmE","https://ap.wps.com/l/cbCaiqj6YhkukvmE","pdf",106933,"English","# Editorial\n## Growing interest in lesion-based neuromodulation and SRS\n## Historical context of psychosurgical overreach\n## Risks and need for ethical, evidence-based approaches","[{\"question\":\"What concern does the editorial raise about using ablative SRS for the nucleus accumbens (NAc)?\",\"answer\":\"It warns that clinical enthusiasm may be getting ahead of evidence for targeting the NAc in psychiatric disorders, risking harms associated with irreversible lesioning.\"},{\"question\":\"How does the editorial connect current SRS proposals to past psychosurgery?\",\"answer\":\"It notes that previous psychosurgical overreach, including frontal lobotomy, helped some patients while also causing serious injuries due to the zeal of treating teams, leading to backlash and stricter oversight.\"},{\"question\":\"What approach does the editorial recommend instead of irreversible NAc ablation?\",\"answer\":\"It advocates a strict, evidence-based and ethically grounded strategy that prioritizes reversible neuromodulation over irreversible lesioning.\"}]","The Perils of Ablative Stereotactic Radiosurgery for the Nucleus Accumbens: A Historical Perspective Urging Caution | PDF",1790589958]