Guridi J, Aldave G
Servicio de Neurocirugía, Clínica Universidad de Navarra, Pamplona, Spain.
Neurocirugia (Astur). 2011 Feb;22(1):5-22.
Deep brain stimulation (DBS) for psychiatric disorders refractory to conventional treatments are currently been performed based on the knowledge obtained in the motor disorder surgery and mainly in Parkinson's disease. Depression, obsessive-compulsive disorder (OCD) and Tourette syndrome, all of them are cortico-striato-thalamo-cortical pathological process involved in the limbic loop of the basal ganglia. This review describes the different targets in these pathological neuro-psychiatric disorders. For OCD there are currently two targets, ventral striatum (VS) Accumbens nucleus (Nacc) and the subthalamic nucleus (STN). In refractory depression the subgenual area (25 Brodmann area) and VS/Nacc. For Tourette syndrome the ventralis oralis internus and centromedianum/parafascicularis of the thalamus (Voi and CM/Pf) and the internal part of the globus pallidus (GPi). Currently there are no specific surgical target for each pathological disorder because clinical results reported are very similar after stimulation surgery. In other point, a selected surgical target also may improve different pathologies.
目前，基于在运动障碍手术（主要是帕金森病手术）中获得的知识，正在对传统治疗难治的精神疾病进行深部脑刺激（DBS）。抑郁症、强迫症（OCD）和图雷特综合征，它们均涉及基底神经节边缘环路中的皮质-纹状体-丘脑-皮质病理过程。本综述描述了这些病理性神经精神疾病中的不同靶点。对于强迫症，目前有两个靶点，即腹侧纹状体（VS）、伏隔核（Nacc）和丘脑底核（STN）。对于难治性抑郁症，靶点是膝下区域（布罗德曼25区）和VS/Nacc。对于图雷特综合征，靶点是丘脑腹内侧核和丘脑中央中核/束旁核（Voi和CM/Pf）以及苍白球内侧部（GPi）。目前，每种病理性疾病尚无特定的手术靶点，因为刺激手术后报告的临床结果非常相似。另一方面，选定的手术靶点也可能改善不同的病症。
