Review of Long-term Results of Stereotactic Psychosurgery.
- 1 January 2002
- journal article
- review article
- Published by Japan Neurosurgical Society in Neurologia medico-chirurgica
- Vol. 42 (9), 365-371
- https://doi.org/10.2176/nmc.42.365
Abstract
Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. Twenty-one patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses since 1993. All were referred from psychiatrists for these disorders. Two patients showed aggressive behavior, 12 had obsessive-compulsive disorder (OCD), and seven had depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were performed for aggressive behavior, limbic leucotomy was performed for OCD, and subcaudate tractotomy with or without cingulotomy was performed for depression with anxiety. OCD was evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the visual analogue scale, the Clinical Global Impression Scale, and the Overt Aggression Scale (OAS). The Mini-Mental State Examination and the Wechsler Adult Intelligence Scale-Revised were used for the evaluation of aggressive behavior. The 17-item Hamilton Depression Rating Scale (HAMD) was used for evaluation of depression. Ventriculography was used in the first seven patients and magnetic resonance imaging-guided stereotaxy was used in the recent 14 cases for localization of the target. The lesions were made with a radiofrequency lesion generator. OAS scores in the two patients with aggressive behavior during follow up declined from 8 to 2 with clinical improvement. All 12 patients with OCD returned to their previous life and showed the mean YBOCS scores decreased from 34 to 3. Ten patients with OCD could be followed up (mean 45 months). All patients returned to their previous social life. In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild transient urinary incontinence. These long-term results indicate that stereotactic psychosurgery is a safe and effective method of treating some medically intractable psychiatric illnesses.Keywords
This publication has 17 references indexed in Scilit:
- PsychosurgeryNeurosurgery Clinics of North America, 1995
- Treatment of obsessive-compulsive disorder by psychosurgeryActa Psychiatrica Scandinavica, 1993
- Cingulotomy for Refractory Obsessive Compulsive DisorderArchives of General Psychiatry, 1991
- NEUROPSYCHOLOGICAL CORRELATES OF STEREOTACTIC SUBCAUDATE TRACTOTOMY A PROSPECTIVE STUDYBrain, 1991
- Visualization of subcaudate tractotomy lesions by magnetic resonance imagingPsychiatry Research, 1989
- Treatment of psychiatric illness by stereotactic cingulotomyBiological Psychiatry, 1987
- Treatment of chronic obsessive compulsive states with stereotactic anterior capsulotomy or cingulotomyActa Neurochirurgica, 1982
- Stereotactic limbic leucotomy—a follow-up study of thirty patientsHeart, 1973
- Stereotactic Limbic Leucotomy: Neurophysiological Aspects and Operative TechniqueThe British Journal of Psychiatry, 1973
- Stereotactic tractotomy in the surgical treatment of mental illnessJournal of Neurology, Neurosurgery & Psychiatry, 1965