Kim Moon-Chan, Lee Tae-Kyu, Choi Chang-Rak
Department of Neurosurgery, Kangnam St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, ROK.
Neurol Med Chir (Tokyo). 2002 Sep;42(9):365-71. doi: 10.2176/nmc.42.365.
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.
立体定向精神外科手术是治疗某些药物难治性精神疾病的有效方法。然而，它并不为人所熟知，且亚洲地区尚未报道其长期临床结果。本文评估了精神外科手术的长期效果，并探讨了其神经解剖学基础。自1993年以来，21例患有药物难治性精神疾病的患者接受了立体定向精神外科手术。所有患者均由精神科医生转诊而来。其中2例表现为攻击行为，12例患有强迫症（OCD），7例患有伴有焦虑症的抑郁症。针对攻击行为实施了双侧杏仁核切开术和尾状核下束切断术，针对OCD实施了边缘白质切断术，针对伴有焦虑症的抑郁症实施了尾状核下束切断术（伴或不伴有扣带回切开术）。使用耶鲁-布朗强迫症量表（YBOCS）、视觉模拟量表、临床总体印象量表和 overt 攻击量表（OAS）对OCD进行评估。使用简易精神状态检查表和韦氏成人智力量表修订版对攻击行为进行评估。使用17项汉密尔顿抑郁量表（HAMD）对抑郁症进行评估。前7例患者采用脑室造影术，最近14例采用磁共振成像引导立体定向术进行靶点定位。使用射频损伤发生器制造损伤。随访期间，2例有攻击行为的患者的OAS评分从8降至2，临床症状有所改善。12例OCD患者均恢复到之前的生活状态，YBOCS平均评分从34降至3。10例OCD患者得到随访（平均45个月）。所有患者均恢复到之前的社交生活状态。7例伴有焦虑症的抑郁症患者的HAMD评分从28.5降至16.5。除1例轻度短暂性尿失禁外，无手术死亡病例，也无明显并发症。这些长期结果表明，立体定向精神外科手术是治疗某些药物难治性精神疾病的一种安全有效的方法。
