Department of Stereotactic Radiotherapy and Radiosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.
Psychiatry Research Group, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.
Prog Brain Res. 2022;272(1):23-31. doi: 10.1016/bs.pbr.2022.03.012. Epub 2022 May 5.
The treatment of mental illnesses that are resistant to conservative therapy poses a serious problem. Surgical methods with proven efficacy have been proposed for only a small group of psychiatric diseases, while in practice non-classical clinical situations are seen rather often. A 36-year-old man with a 18-year history of "schizophrenia with a predominant obsessive-compulsive syndrome" was referred to the Burdenko National Medical Research Center of Neurosurgery for consideration of neurosurgical treatment. Based on results of longitudinal independent evaluations of the patient in several specialized clinical centers the disease was considered resistant to medical therapy. Radiosurgical procedure was performed by means of Leksell Gamma Knife Perfexion™ (Elekta AB; Stockholm, Sweden). Ventral portion of the anterior limb of internal capsule was targeted with two 4-mm isocenters on each side, with prescription dose at 50% isodose line of 80 Gy and a maximal dose of 160 Gy. No obvious complications or side effects were noted during 13-month follow-up after radiosurgery. Gradual clinical improvement was observed with 25% reduction of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at 13 months after treatment. Similarly, the Hospital Anxiety and Depression Scale (HADS) anxiety and depression scores decreased by 24% and 58%, respectively. This is the first published case of radiosurgical treatment of a psychiatric disorder in Russia. It demonstrates the potential efficacy of Gamma Knife capsulotomy for non-classical forms of obsessive-compulsive disorder comorbid with schizophrenia. Nevertheless, definitive conclusions about the reliability of this radiosurgical indication can only be made based on the results of larger studies.
抗保守治疗的精神疾病的治疗构成了严重的问题。具有已证实疗效的手术方法仅适用于一小部分精神疾病，而在实践中，经常出现非典型的临床情况。一名 36 岁男子，患有 18 年的“以强迫性综合征为主的精神分裂症”，被转介到 Burdenko 国家神经外科医学研究中心，以考虑神经外科治疗。基于对该患者在几个专业临床中心进行的纵向独立评估结果，该疾病被认为对药物治疗有抗性。通过 Leksell Gamma Knife Perfexion™（Elekta AB；斯德哥尔摩，瑞典）进行放射外科手术。通过在每侧的两个 4mm 等中心点对内囊前肢的腹侧部分进行靶向治疗，处方剂量为 50%等剂量线 80Gy 和最大剂量 160Gy。放射外科手术后 13 个月的随访期间，未观察到明显的并发症或副作用。在治疗后 13 个月，耶鲁-布朗强迫症量表（Y-BOCS）评分降低了 25%，观察到逐渐的临床改善。同样，医院焦虑和抑郁量表（HADS）的焦虑和抑郁评分分别降低了 24%和 58%。这是俄罗斯首例发表的放射外科治疗精神障碍的病例。它证明了伽玛刀囊切开术治疗伴发精神分裂症的非典型强迫症的潜力。然而，只有通过更大规模的研究结果，才能对这种放射外科适应症的可靠性做出明确的结论。
