Tratamiento neuroquirúrgico de trastornos psiquiátricos: Experiencia del centro regional de neurocirugía de Tacuarembó, Uruguay

Pablo Hernández; Fernando Martínez

doi:10.47924/neurotarget2008424

Authors

Pablo Hernández Functional Neurosurgery and Stereotaxy Unit Tacuarembó Regional Neurosurgery Center Tacuarembó Regional Hospital, Uruguay
Fernando Martínez Functional Neurosurgery and Stereotaxy Unit Tacuarembó Regional Neurosurgery Center Tacuarembó Regional Hospital, Uruguay

DOI:

https://doi.org/10.47924/neurotarget2008424

Keywords:

stereotaxy, stereotactic and functional neurosurgery, depression, aggressiveness, obsessive-compulsive disorder

Abstract

Introduction: Despite the extensive regional experience in the treatment of psychiatric disorders through stereotaxic ablative surgery, in Uruguay there are no publications on the matter. The present work constitutes the report of the preliminary results of the first series of patients with psychiatric diseases operated on in Uruguay who underwent radiofrequency ablation using stereotaxy.
Patients and methods: In a period of two years, 5 patients were operated on: 2 of them for irreducible aggression, 2 for obsessive-compulsive disorder (OCD) and one for chronic pain and depression. In the first two cases, a bilateral postero-medial hypothalamotomy was performed and in the remaining cases, a bilateral anterior cingulotomy was performed.
Results: In cases of aggressiveness, after a 6-month follow-up, a notable improvement was evident according to the evaluation with the Yudofsky Manifest Aggression Scale; in case one the score on this scale decreased from 11 to 6 and in case two from 19 to 7; In case one, at 12 months the score was 4, but at 24 months it relapsed and was 8 points. In the cases of OCD, improvement was evident after 6 months in patient one as she went from 37 to 21 points on the Yale-Brown Obsessive Compulsive Scale; In case two, the surgery was done recently and we have not yet evaluated the result objectively. The patient operated on for depression and pain showed improvement; after 6 months he went from 30 points to 1 on the Beck Depression Inventory II; However, at 14 months he reached a score of 19.
Conclusions: Although this is a small series with short follow-up periods, which prevents adequate statistical analysis, it can be preliminarily concluded that the results of ablative surgery have been satisfactory.

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References

Arana R, Galeano J. Psicocirugía. Anales del Instituto de Neurología, Uruguay. 1950;8:183-268.

Hernández P, Prinzo H, Martínez F, Erman A, Ricagni F, Retamoso I, et al. Primeros dos años de trabajo de la Unidad de Neurocirugía Funcional y Estereotaxia del Hospital Regional de Tacuarembó, Uruguay. Neurotarget. 2006;1(2):28-34.

Hernández P, Orrego M, Prinzo H, Martínez F, Medina C, Pollo E. Tratamiento neuroquirúrgico de la agresividad irreductible: hipotalamotomía pósteromedial estereotáxica. Rev Med Urug. 2007;23:126-33.

Hernández P, Martínez F, Montes M, Retamoso I. Dolor talámico y depresión: tratamiento mediante cingulotomía anterior estereotáxica. Neurotarget 2007;2(3):12-5.

Sano K, Mayanagi Y. Posteromedial hypothalamotomy in the treatment of violent, aggressive behaviour. Acta Neurochir Suppl (Wien). 1988;44:145-51.

Sano K, Mayanagi Y, Sekino H, Ogashiwa M, Ishijima B. Results of timulation and destruction of the posterior hypothalamus in man. J Neurosurg. 1970;33(6):689-707.

Sano K. Aggressiveness. In: Schaltenbrand G, Walker AE. Stereotaxy of the human brain. Anatomical, physiological and clinical application. Stuttgart: Georg Thieme Verlag; 1982. p. 617-21.

Ballantine HT, Cosgrove GR, Giriunas IE. Surgical treatment of intractable psychiatric illness and chronic pain by stereotactic cingulotomy. In: Schmidek H, Sweet W, editors. Operative neurosurgical techniques. Philadelphia: WB Saunders Company; 1995. p. 1423-30.

Gybels J, Cosyns P. Cerebral lesions for psychiatric disorders and pain. In: Schmidek H, Sweet W, editors. Operative neurosurgical techniques. Philadelphia: WB Saunders Company; 1995. p. 1413-22.

De Oliveira JO Jr. Cingulotomía para o controle da dor. Neurotarget. 2006;1(1):33-6.

Wilkinson HA, Davidson KM, Davidson RI. Bilateral anterior cingulotomy for chronic noncancer pain. Neurosurgery. 1999;45(5):1129-34.

Yen CP, Kung SS, Su YF, Lin WC, Howng SL, Kwan AL. Stereotactic bilateral anterior cingulotomy for intractable pain. J Clin Neurosci. 2005;12(8):886-90.

Binder DK, Iskandar BJ. Modern neurosurgery for psychiatric disorders. Neurosurgery. 2000;47(1):9-21.

Feldman RP, Alterman RL, Goodrich JT. Contemporary psychosurgery and a look to the future. J Neurosurg. 2001;95(6):944-56.

Pedrosa M, Sola RG. La moderna psicocirugía: un nuevo enfoque de la neurocirugía en la enfermedad psiquiátrica. Rev Neurol. 2003;36(9):887-97.

Hernando V, Pastor J, Garcia E, Sola RG. Psicocirugía y tratamiento neuroquirúrgico del dolor: revisión sistemática de la experiencia alcanzada en estos tipos de tratamiento. Rev Neurol 2004;38(10):949-56.

Franzini A, Marras C, Ferroli P, Bugiani O, Broggi G. Stimulation of the posterior hypothalamus for medically intractable impulsive and violent behavior. Stereotact Funct Neurosurg. 2005;83(2-3):63-6.

Anderson D, Ahmed A. Treatment of patients with intractable obsessive-compulsive disorder with anterior capsular stimulation. Case report. J Neurosurg. 2003;98(5):1104-8.

Nuttin BJ, Gabriëls LA, Cosyns PR, Meyerson BA, Andréewitch S, Sunaert SG, et al. Long-term electrical capsular stimulation in patients with obses- sive-compulsive disorder. Neurosurgery. 2003;52(6):1263-72.

Seijo-Zazo E, Seijo-Fernández F, Fernández-González F, Álvarez-Vega MA, Lozano-Aragoneses B. Propuesta de una nueva diana para la estimulación cerebral profunda en el trastorno obsesivo-compulsivo. Rev Neurol. 2007;45(7):424-8.