Jiménez Fiacro, Soto Julián E, Velasco Francisco, Andrade Pablo, Bustamante Juan J, Gómez Paulina, Ramírez Ylián, Carrillo-Ruiz José D
Functional Neurosurgery, Stereotactic and Radiosurgery Unit, Anáhuac University, Mexico City, Mexico.
Stereotact Funct Neurosurg. 2012;90(3):151-60. doi: 10.1159/000336746. Epub 2012 Apr 11.
To perform a preliminary study on the effects and safety of bilateral cingulotomy and anterior capsulotomy in patients with aggressive behavior.
Twenty-three psychiatric patients showing aggressive behavior refractory to conventional treatment were initially evaluated. The subjects were clinically selected using the Overt Aggression Scale (OAS) and the Global Assessment of Functioning Scale (GAF). Each case was carefully reviewed by the Ethics Committee of Mexico's General Hospital. Once selection criteria were met, stereotactic lesions were made using radiofrequency on the anterior limb of the internal capsule and supragenual cingulum. Statistical differences were evaluated with a Wilcoxon test at 6 months and at 4 years.
Ten patients underwent surgery. Their OAS and GAF scores decreased after the procedure at the 6-month (p < 0.05) and at the 4-year (p = 0.068) follow-up. Four patients showed mild and transitory postsurgical complications (hyperphagia and somnolence).
Bilateral anterior capsulotomy in combination with cingulotomy may reduce aggressive behavior and improve clinical evaluations. Very strict clinical and ethical evaluations were applied prior to considering patients for this treatment.
对双侧扣带回切开术和前扣带切开术治疗攻击性行为患者的疗效和安全性进行初步研究。
对23例经传统治疗后攻击行为仍难以控制的精神科患者进行了初步评估。使用明显攻击量表（OAS）和功能总体评定量表（GAF）对受试者进行临床筛选。每例患者均由墨西哥综合医院伦理委员会仔细审查。一旦符合入选标准，便使用射频在内囊前肢和膝上扣带回制造立体定向损伤。在6个月和4年时采用Wilcoxon检验评估统计学差异。
10例患者接受了手术。在6个月（p < 0.05）和4年（p = 0.068）随访时，术后他们的OAS和GAF评分下降。4例患者出现轻度短暂的术后并发症（贪食和嗜睡）。
双侧前扣带切开术联合扣带回切开术可能会减少攻击行为并改善临床评估。在考虑对患者进行这种治疗之前，进行了非常严格的临床和伦理评估。
