Lipsman N, Gerretsen P, Torres C, Lozano A M, Giacobbe P
University of Toronto, Toronto, Canada.
J Neurosurg Sci. 2012 Sep;56(3):209-20.
There is increasing attention in the neurosurgical literature towards surgery, specifically deep brain stimulation (DBS), for psychiatric indications. Several positive trials have spurred intense investigation and research in this area, owing to rapid advances in the neurosciences. As a result, the scope of neurosurgical practice is evolving to now include disorders that weren't traditionally in the purview of the average functional neurosurgeon. Further, functional neurosurgeons are now being charged with taking care of patients as part of a multi-disciplinary group that includes psychologists and psychiatrists. As DBS for psychiatry continues to evolve, and as further indications are explored, it is incumbent on neurosurgeons who treat these disorders to familiarize themselves with current standards of diagnosis and treatment. Just as the movement disorder surgeon should be familiar with the biology, physiology, diagnosis and treatment of Parkinson's disease, so they should become familiar with similar aspects of commonly referred psychiatric conditions. Specifically, much of the interest in the DBS literature currently surrounds major depression, obsessive-compulsive disorder and Tourette's syndrome. Here, we review the epidemiology, diagnostic criteria, hypothesized neurocircuitry and current treatments, both medical and surgical of each of these conditions to serve as a centralized, introductory primer for the practicing functional neurosurgeon.
神经外科文献中对针对精神疾病适应症的手术，尤其是深部脑刺激（DBS）的关注日益增加。由于神经科学的快速发展，一些阳性试验激发了该领域的深入研究。因此，神经外科手术的范围正在不断演变，现在包括了传统上普通功能神经外科医生范畴之外的疾病。此外，功能神经外科医生现在还负责作为包括心理学家和精神科医生在内的多学科团队的一部分来照顾患者。随着用于精神疾病的DBS不断发展，以及更多适应症的探索，治疗这些疾病的神经外科医生有责任熟悉当前的诊断和治疗标准。正如运动障碍外科医生应该熟悉帕金森病的生物学、生理学、诊断和治疗一样，他们也应该熟悉常见精神疾病的类似方面。具体而言，目前DBS文献中的大部分兴趣集中在重度抑郁症、强迫症和妥瑞氏综合征上。在此，我们回顾这些疾病各自的流行病学、诊断标准、假定的神经回路以及当前的医学和手术治疗方法，为执业功能神经外科医生提供一个集中的入门指南。
