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Progress in Brain Research 2022Making lesions in the brain to relieve the distress of mental illness has had a checkered career due to a mixture of misuse and also caution about making permanent...
Making lesions in the brain to relieve the distress of mental illness has had a checkered career due to a mixture of misuse and also caution about making permanent lesions in the brain where there was no physical abnormality. However, over the last 10 years a more flexible approach has developed. The method is still in its infancy and very little used. However, GKNS has been shown to be useful for OCD and also some cases of sever anxiety. It has been attempted for depression and anorexia nervosa but at present its role for these conditions remains to be determined.
Topics: Anxiety; Anxiety Disorders; Brain; Humans; Obsessive-Compulsive Disorder; Psychosurgery
PubMed: 35074092
DOI: 10.1016/bs.pbr.2021.10.043 -
Brain Sciences Dec 2021Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized...
Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized patients. We aimed to characterize the neurophysiological properties posteromedial hypothalamus (PMH), identified by the best neurophysiological response to electrical stimulation. We obtained microelectrode recordings from four patients with intractable aggressivity operated under general anesthesia. We pooled data from 1.5 mm at PMH, 1.5 mm upper (uPMH) and 1.5 mm lower (lPMH). We analyzed 178 units, characterized by the mean action potential (mAP). Only 11% were negative. We identified the next types of units: P1N1 (30.9%), N1P1N2 (29.8%), P1P2N1 (16.3%), N1P1 and N1N2P1 (6.2%) and P1N1P2 (5.0%). Besides, atypical action potentials (amAP) were recorded in 11.8%. PMH was highly different in cell composition from uPMH and lPMH, exhibiting also a higher percentage of amAP. Different kinds of cells shared similar features for the three hypothalamic regions. Although features for discharge pattern did not show region specificity, the probability mass function of inter-spike interval were different for all the three regions. Comparison of the same kind of mAP with thalamic neurons previously published demonstrate that most of cells are different for derivatives, amplitude and/or duration of repolarization and depolarization phases and also for the first phase, demonstrating a highly specificity for both brain centers. Therefore, the different properties described for PMH can be used to positively refine targeting, even under general anesthesia. Besides, we describe by first time the presence of atypical extracellular action potentials.
PubMed: 35053786
DOI: 10.3390/brainsci12010043 -
World Neurosurgery Mar 2022Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy. Since it was first performed in 1940, numerous studies have assessed its outcomes... (Review)
Review
Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy. Since it was first performed in 1940, numerous studies have assessed its outcomes in various patient populations in addition to describing different extents of sectioning and emerging technologies (i.e., endoscopic, laser interstitial thermal therapy, and radiosurgery). To capture the current state and offer a reappraisal, we comprehensively review the origins of corpus callosotomy, efficacy for various seizure types, technical variations, complications, and indications and compare the procedure with vagus nerve stimulation therapy, which has similar indications. We consider corpus callosotomy to be a safe and efficacious procedure, which should be considered by clinicians when appropriate. Furthermore, it can play an important role in treating patients with drug-resistant epilepsy when appropriate in low-to-middle-income countries where resources are limited.
Topics: Corpus Callosum; Drug Resistant Epilepsy; Humans; Psychosurgery; Treatment Outcome; Vagus Nerve Stimulation
PubMed: 35033693
DOI: 10.1016/j.wneu.2022.01.037 -
Operative Neurosurgery (Hagerstown, Md.) Apr 2022
Topics: Hemispherectomy; Humans; Psychosurgery; Stereotaxic Techniques
PubMed: 34989708
DOI: 10.1227/ONS.0000000000000088 -
Journal of Neurosurgery Sep 2022Dr. William Beecher Scoville (1906-1984) is a giant figure in the history of neurosurgery, well known by the public for his operation on Patient H.M. He developed dozens...
Dr. William Beecher Scoville (1906-1984) is a giant figure in the history of neurosurgery, well known by the public for his operation on Patient H.M. He developed dozens of neurosurgical instruments and techniques, with many tools named after him that are still widely used today. He founded numerous neurosurgical societies around the world. He led the movement in psychosurgery, developing the technique of selective orbital undercutting and performing hundreds of lobotomies throughout his career. However, his many contributions to the advancement of neurosurgery have not been well described in the medical literature. To bridge the knowledge gap, this article seeks to detail the life and career of William Beecher Scoville and bring to attention the enduring impact of his work.
PubMed: 34952520
DOI: 10.3171/2021.10.JNS211907 -
Revista Colombiana de Psiquiatria... 2021Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success...
INTRODUCTION
Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients.
METHODS
A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy.
RESULTS
The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia.
CONCLUSIONS
Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
Topics: Anterior Temporal Lobectomy; Depressive Disorder, Major; Female; Follow-Up Studies; Humans; Male; Psychosurgery; Treatment Outcome
PubMed: 34742698
DOI: 10.1016/j.rcpeng.2020.05.002 -
Journal of Neurosurgery Apr 2022One of the few resources for treating medically intractable pain is ablative surgery, but its indications have fallen dramatically over the last decades. One such... (Review)
Review
OBJECTIVE
One of the few resources for treating medically intractable pain is ablative surgery, but its indications have fallen dramatically over the last decades. One such procedure is mesencephalotomy. This study aims to determine current risks and benefits of MR-guided semidirect targeting-based stereotactic mesencephalotomy.
METHODS
This was a retrospective study based on a review of the medical records of 22 patients with nociceptive (n = 5), neuropathic (n = 10), or mixed (n = 7) refractory pain treated with unilateral mesencephalotomy alone (17 patients) or associated with bilateral anterior cingulotomy (5 patients) between 2014 and 2021 in the authors' institutions. The confidence interval adopted in this study was 95%.
RESULTS
The sample included 12 women and 10 men with ages ranging from 23 to 80 years (mean 55.1 ± 17.1 years). Using MR-guided semidirect targeting, the following structures were targeted: spinoreticulothalamic (neuropathic/mixed pain, n = 17), trigeminothalamic (nociceptive/mixed pain in the face, n = 5), and neospinothalamic (nociceptive/mixed pain in the body, n = 7) pathways. The most common response to macrostimulation was central heat/moderate discomfort. Radiofrequency thermocoagulation was made with 70°C-75°C/60 sec. A total of 86.3% (3 months) and 76.9% (12 months) of the patients achieved excellent or good results (improvement of pain > 50%), presenting with a significant mean pain relief of 80.1% at 3 months and 71.4% at 12 months postoperatively. The addition of bilateral anterior cingulotomy did not improve the results. Patients with upper limb, cervicobrachial, and face pain did significantly better than those with trunk pain. The worst results were seen in patients with neuropathic and/or trunk pain. The surgical failure (pain relief ≤ 25%) and recurrence rates were 9.1% each, apparently related to the use of lower lesioning parameters (70°C/60 sec) and to the presence of neuropathic and/or trunk pain. The morbidity rate was 8%, with both complications (vertical diplopia and confusion/agitation) happening in patients lesioned with 75°C/60 sec. There were no deaths in this series.
CONCLUSIONS
These results show that contemporary stereotactic mesencephalotomy is an effective, relatively low-risk, and probably underused procedure for treating medically intractable pain. Careful semidirect determination of the target coordinates associated with close attention to electrical macrostimulation responses certainly plays an important role in avoiding complications in most of the procedures. A higher lesioning temperature (75°C) apparently prevents recurrence, but at the cost of an increased risk of complications.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Pain, Intractable; Psychosurgery; Retrospective Studies; Stereotaxic Techniques; Young Adult
PubMed: 34678784
DOI: 10.3171/2021.6.JNS21709 -
Neurologia I Neurochirurgia Polska 2021Deep brain stimulation (DBS) has achieved substantial success as a treatment for movement disorders such as Parkinson's Disease (PD), essential tremor (ET), and... (Review)
Review
INTRODUCTION
Deep brain stimulation (DBS) has achieved substantial success as a treatment for movement disorders such as Parkinson's Disease (PD), essential tremor (ET), and dystonia. More recently, a limited number of basic and clinical studies have indicated that DBS of the nucleus accumbens (NAc) and other neighbouring structures of the reward circuit may be an effective intervention for patients with treatment-refractory addiction.
MATERIAL AND METHODS
We performed a structured literature review of human studies of DBS for addiction outlining the clinical efficacy and adverse events. We found 14 human studies targeting mostly the NAc with neighbouring structures such as anterior limb of the internal capsule (ALIC). Five studies including 12 patients reported the outcomes for alcohol dependence. Nine studies including 18 patients reported the outcomes for addictions to various psychoactive substances. The most common indication was addiction to heroin, found in 13 patients, followed by methamphetamine, 3 patients, cocaine, one patient, and polysubstance drug abuse in one patient.
CONCLUSIONS
The limited clinical data available indicates that DBS may be a promising therapeutic modality for the treatment of intractable addiction. In general, the safety profile of DBS in patients with addiction is good. Based on the data published in the literature, the NAc is the most often targeted, and is probably the most effective, structure of the reward circuit in the treatment of addiction in humans. Given the ever-expanding understanding of the psychosurgery of addiction, DBS could in the future be a treatment option for patients suffering from intractable addictive disorders.
Topics: Deep Brain Stimulation; Humans; Internal Capsule; Nucleus Accumbens; Substance-Related Disorders; Treatment Outcome
PubMed: 34633060
DOI: 10.5603/PJNNS.a2021.0065 -
Surgical Neurology International 2021Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for...
BACKGROUND
Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or associated with anterior cingulotomy. No improvement of hallucinations and delusions was noticed in any of these patients. To improve the control of aggression, subcaudate tractotomy was added to the previous surgical protocol. The main goal of the present study was to investigate the impact of this modified surgical approach on delusions and hallucinations.
METHODS
Retrospective analysis of the medical records of psychotic patients presenting with treatment-resistant aggressiveness, delusions, and hallucinations submitted to bilateral subcaudate tractotomy + bilateral anterior cingulotomy + bilateral amygdalotomy in our institution.
RESULTS
Five patients, all males, with ages ranging from 25 to 65 years, followed up by a mean of 45.6 months (17-72 months), fulfilled the inclusion criteria. Delusions and hallucinations were abolished in four of them.
CONCLUSION
These results suggest that the key element for relieving these symptoms was the subcaudate tractotomy and that the orbitofrontal and ventromedial prefrontal cortices play an important role in the genesis of hallucinatory and delusional symptoms of schizophrenia and other psychoses.
PubMed: 34621590
DOI: 10.25259/SNI_599_2021 -
Stereotactic and Functional Neurosurgery 2022Corpus callosotomy for medically intractable epilepsy is an effective ablative procedure traditionally achieved using either standard open craniotomy or with...
BACKGROUND
Corpus callosotomy for medically intractable epilepsy is an effective ablative procedure traditionally achieved using either standard open craniotomy or with less-invasive approaches. Advances in robotic-assisted stereotactic guidance for neurosurgery can be applied for LITT for corpus callosotomy.
CLINICAL PRESENTATIONS
Two patients were included in this study. One was a 25-year-old female patient with extensive bi-hemispheric malformations of cortical development and medically refractory epilepsy, and the other was an 18-year-old male with medically refractory epilepsy and atonic seizures, who underwent a complete corpus callosotomy using robotic-assisted stereotactic guidance for LITT.
RESULTS
Both patients underwent successful intended corpus callosotomy with volumetric analysis demonstrating a length disconnection of 74% and a volume disconnection of 55% for patient 1 and a length disconnection of 83% and a volume disconnection of 33% for patient 2. Postoperatively, both patients had clinical reductions in seizure.
CONCLUSION
Our experience demonstrates that robotic guidance systems can safely and effectively be adapted for minimally invasive LITT corpus callosotomy.
Topics: Adolescent; Adult; Corpus Callosum; Drug Resistant Epilepsy; Female; Humans; Laser Therapy; Male; Psychosurgery; Robotic Surgical Procedures; Treatment Outcome
PubMed: 34515241
DOI: 10.1159/000518109