Psychedelics in neurosurgery: Potential utility in prevention, perioperative care, pain management, and neurorehabilitation.
- 1Department of Neurosurgery, National Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez', Mexico City, Mexico.
- 2Faculty of Health Sciences, Universidad del Valle de México Campus Querétaro, Queretaro, Mexico.
- 3Faculty of Medicine, Universidad Panamericana, Mexico City, Mexico.
Abstract
Background
Neurosurgical patients carry a high and frequently undertreated burden of psychological suffering, acute and chronic pain, and neurological deficits amenable to recovery. The resurgence of psychedelic research has produced relevant evidence in adjacent fields, but its applicability to neurosurgery has not been systematized. This review synthesizes that evidence across prevention, perioperative care, pain management, and neurorehabilitation, and delineates the safety considerations specific to neurosurgery.Methods
Narrative review structured around a population, intervention, comparator, outcome, and time question, covering 2020-2026. The classic serotonergic psychedelics (psilocybin, lysergic acid diethylamide [LSD], N,N-dimethyltryptamine, ayahuasca, 5-methoxy-N,N-dimethyltryptamine, and mescaline), the iboga alkaloid ibogaine, the entactogen 3,4-methylenedioxymethamphetamine, and the dissociatives ketamine and esketamine were examined. Randomized controlled trials, systematic reviews, meta-analyses, and high-quality mechanistic studies were prioritized.Results
No trial has administered these agents in neurosurgical cohorts, so all evidence is indirect. Psilocybin- assisted therapy produces substantial, durable reductions in cancer-related depression, anxiety, and existential distress. LSD is anxiolytic; parenteral tryptamines act rapidly in depression; ibogaine improved disability, post- traumatic stress, and cognition after traumatic brain injury but carries arrhythmia risk. Perioperative ketamine and esketamine show antidepressant and opioid-sparing effects. Classic psychedelics promote neuroplasticity and are neuroprotective in preclinical models.Conclusion
A biologically plausible basis exists for exploring these agents in neurosurgery, but direct evidence is absent and translation is constrained by the seizure threshold, hemodynamic and cerebrovascular effects, perioperative serotonergic interactions, and the need for structured psychological support. Perioperative esketamine and psilocybin for neuro-oncological distress are the most feasible starting points. Purpose-designed neurosurgical trials are required.
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BibTeX
@article{garciabitar2026psychedelics,
title = {{Psychedelics in neurosurgery: Potential utility in prevention, perioperative care, pain management, and neurorehabilitation.}},
author = {Andrea Garcia-Bitar and Eduardo Jesus Castañeda and José Rafael Buenrostro-Rangel and Ana Karilú Vázquez-Flores and Pablo Diego Santibañez-Patiño and Sergio Moreno-Jiménez},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_962_2026},
url = {https://europepmc.org/article/MED/42974518},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Psychedelics in neurosurgery: Potential utility in prevention, perioperative care, pain management, and neurorehabilitation.
AU - Andrea Garcia-Bitar
AU - Eduardo Jesus Castañeda
AU - José Rafael Buenrostro-Rangel
AU - Ana Karilú Vázquez-Flores
AU - Pablo Diego Santibañez-Patiño
AU - Sergio Moreno-Jiménez
PY - 2026
DA - 2026/10/09
JO - Surgical neurology international
DO - 10.25259/sni_962_2026
UR - https://europepmc.org/article/MED/42974518
AB - Background Neurosurgical patients carry a high and frequently undertreated burden of psychological suffering, acute and chronic pain, and neurological deficits amenable to recovery. The resurgence of psychedelic research has produced relevant evidence in adjacent fields, but its applicability to neurosurgery has not been systematized. This review synthesizes that evidence across prevention, perioperative care, pain management, and neurorehabilitation, and delineates the safety considerations specific to neurosurgery.Methods Narrative review structured around a population, intervention, comparator, outcome, and time question, covering 2020-2026. The classic serotonergic psychedelics (psilocybin, lysergic acid diethylamide [LSD], N,N-dimethyltryptamine, ayahuasca, 5-methoxy-N,N-dimethyltryptamine, and mescaline), the iboga alkaloid ibogaine, the entactogen 3,4-methylenedioxymethamphetamine, and the dissociatives ketamine and esketamine were examined. Randomized controlled trials, systematic reviews, meta-analyses, and high-quality mechanistic studies were prioritized.Results No trial has administered these agents in neurosurgical cohorts, so all evidence is indirect. Psilocybin- assisted therapy produces substantial, durable reductions in cancer-related depression, anxiety, and existential distress. LSD is anxiolytic; parenteral tryptamines act rapidly in depression; ibogaine improved disability, post- traumatic stress, and cognition after traumatic brain injury but carries arrhythmia risk. Perioperative ketamine and esketamine show antidepressant and opioid-sparing effects. Classic psychedelics promote neuroplasticity and are neuroprotective in preclinical models.Conclusion A biologically plausible basis exists for exploring these agents in neurosurgery, but direct evidence is absent and translation is constrained by the seizure threshold, hemodynamic and cerebrovascular effects, perioperative serotonergic interactions, and the need for structured psychological support. Perioperative esketamine and psilocybin for neuro-oncological distress are the most feasible starting points. Purpose-designed neurosurgical trials are required.
SN - 2229-5097
SN - 2152-7806
ER -