University of Iowa Carver College of Medicine, Iowa City, Iowa.
Department of Neurosurgery.
Neurosurg Focus. 2017 Sep;43(3):E8. doi: 10.3171/2017.6.FOCUS17227.
Neurosurgery for the treatment of psychological disorders has a checkered history in the United States. Prior to the advent of antipsychotic medications, individuals with severe mental illness were institutionalized and subjected to extreme therapies in an attempt to palliate their symptoms. Psychiatrist Walter Freeman first introduced psychosurgery, in the form of frontal lobotomy, as an intervention that could offer some hope to those patients in whom all other treatments had failed. Since that time, however, the use of psychosurgery in the United States has waxed and waned significantly, though literature describing its use is relatively sparse. In an effort to contribute to a better understanding of the evolution of psychosurgery, the authors describe the history of psychosurgery in the state of Iowa and particularly at the University of Iowa Department of Neurosurgery. An interesting aspect of psychosurgery at the University of Iowa is that these procedures have been nearly continuously active since Freeman introduced the lobotomy in the 1930s. Frontal lobotomies and transorbital leukotomies were performed by physicians in the state mental health institutions as well as by neurosurgeons at the University of Iowa Hospitals and Clinics (formerly known as the State University of Iowa Hospital). Though the early technique of frontal lobotomy quickly fell out of favor, the use of neurosurgery to treat select cases of intractable mental illness persisted as a collaborative treatment effort between psychiatrists and neurosurgeons at Iowa. Frontal lobotomies gave way to more targeted lesions such as anterior cingulotomies and to neuromodulation through deep brain stimulation. As knowledge of brain circuits and the pathophysiology underlying mental illness continues to grow, surgical intervention for psychiatric pathologies is likely to persist as a viable treatment option for select patients at the University of Iowa and in the larger medical community.
神经外科治疗心理障碍在美国的历史可谓一波三折。在抗精神病药物问世之前，患有严重精神疾病的人被收容住院，并接受极端治疗，试图缓解他们的症状。精神病学家 Walter Freeman 首次引入了脑白质切除术，作为一种干预手段，为那些所有其他治疗方法都失败的患者带来一线希望。然而，自那时以来，尽管描述其使用的文献相对较少，但美国对精神外科的使用却经历了显著的兴衰。为了更好地理解精神外科的发展历程，作者描述了爱荷华州的精神外科历史，特别是爱荷华大学神经外科的历史。爱荷华大学精神外科的一个有趣方面是，自 20 世纪 30 年代 Freeman 引入脑白质切除术以来，这些手术几乎一直在进行。州立精神病院的医生和爱荷华大学医院和诊所（前身为爱荷华州立大学医院）的神经外科医生都进行了额叶切除术和眶间白质切开术。尽管早期的额叶切除术技术很快失宠，但神经外科治疗特定的难治性精神疾病的应用作为精神病学家和神经外科医生在爱荷华州的合作治疗努力一直存在。额叶切除术让位于更具针对性的病变，如前扣带切开术，以及通过深部脑刺激进行神经调节。随着对大脑回路和精神疾病基础病理生理学的认识不断提高，针对精神病理学的手术干预可能会作为一种可行的治疗选择，为爱荷华大学和更大的医学社区中的特定患者保留下来。
