Korzenev A V, Shoustin V A, Anichkov A D, Polonskiy J Z, Nizkovolos V B, Oblyapin A V
Bechterev Psychoneurological Research Institute, Russian Academy of Sciences, Saint Petersburg, Russia.
Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):226-30. doi: 10.1159/000099929.
One of the most frequent indications of psychosurgical treatment is incurable obsessions. Up to now, capsulotomy or cingulotomy has been preferred. In our opinion, the variety of obsessive conditions require a more thorough approach to the selection of interbrain targets. Forty-seven patients with pure obsessive-compulsive disorders as well as disorders connected with depressions, epileptic syndrome, schizophreniform state and Gilles de la Tourette's syndrome with extremely severe resistance to medical therapy were examined. Eighteen patients were operated on. Surgical treatment is permissible only in cases fulfilling the three following criteria: (1) clinicopsychopathological permissibility (duration of disease, resistance to medication, psychopathological status); (2) physiological permissibility (the presence of a brain target, defining the psychopathological status), and (3) technical permissibility (the availability of proper stereotactic, imaging, electrophysiological and other apparatus necessary to carry out the surgical treatment). One supposes that the outcome of surgical treatment is determined by all three criteria. For the purpose of improving the efficiency of stereotactic treatment, a number of methods of surgical treatment depending on the psychopathological status are suggested. For example, in case of comorbidity of obsession with the epileptiform syndrome, we suggest cingulotomy (capsulotomy) and amygdalotomy; in case of comorbidity with depression we suggest cingulotomy and innominatotomy. The long-term observation of the outcome of stereotactic treatment covers a period from 2 up to 9 years.
精神外科治疗最常见的适应症之一是无法治愈的强迫观念。到目前为止，人们更倾向于采用内囊切开术或扣带回切开术。我们认为，各种强迫状态需要更全面地选择间脑靶点。对47例患有单纯强迫症以及与抑郁症、癫痫综合征、精神分裂症样状态和 Gilles de la Tourette 综合征相关的疾病且对药物治疗具有极强耐药性的患者进行了检查。18例患者接受了手术。仅在满足以下三个标准的情况下才允许进行手术治疗：（1）临床心理病理学许可（疾病持续时间、对药物的耐药性、心理病理学状态）；（2）生理许可（存在定义心理病理学状态的脑靶点），以及（3）技术许可（具备进行手术治疗所需的适当立体定向、成像、电生理和其他设备）。人们认为手术治疗的结果由所有这三个标准决定。为了提高立体定向治疗的效率，根据心理病理学状态提出了一些手术治疗方法。例如，在强迫观念与癫痫样综合征合并的情况下，我们建议进行扣带回切开术（内囊切开术）和杏仁核切开术；在与抑郁症合并的情况下，我们建议进行扣带回切开术和无名质切开术。立体定向治疗结果的长期观察涵盖了2至9年的时间。
