Stereotactic Limbic Leucotomy: Neurophysiological Aspects and Operative Technique

Kelly, Desmond; Richardson, Alan; Mitchell-Heggs, Nita

doi:10.1192/bjp.123.2.133

Cited by 108 publications

(62 citation statements)

References 19 publications

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“…15) Limbic leucotomy combined bilateral cingulotomy with subcaudate tractotomy, which was introduced in 1973. 13,14) The idea was that this duallesion technique would produce better functional M.-C. Kim et al…”

Section: Discussionmentioning

confidence: 99%

Review of Long-term Results of Stereotactic Psychosurgery.

Kim

Lee

Choi

2002

Neurol. Med. Chir.(Tokyo)

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Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. Twenty-one patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses since 1993. All were referred from psychiatrists for these disorders. Two patients showed aggressive behavior, 12 had obsessive-compulsive disorder (OCD), and seven had depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were performed for aggressive behavior, limbic leucotomy was performed for OCD, and subcaudate tractotomy with or without cingulotomy was performed for depression with anxiety. OCD was evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the visual analogue scale, the Clinical Global Impression Scale, and the Overt Aggression Scale (OAS). The Mini-Mental State Examination and the Wechsler Adult Intelligence ScaleRevised were used for the evaluation of aggressive behavior. The 17-item Hamilton Depression Rating Scale (HAMD) was used for evaluation of depression. Ventriculography was used in the first seven patients and magnetic resonance imaging-guided stereotaxy was used in the recent 14 cases for localization of the target. The lesions were made with a radiofrequency lesion generator. OAS scores in the two patients with aggressive behavior during follow up declined from 8 to 2 with clinical improvement. All 12 patients with OCD returned to their previous life and showed the mean YBOCS scores decreased from 34 to 3. Ten patients with OCD could be followed up (mean 45 months). All patients returned to their previous social life. In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild transient urinary incontinence. These long-term results indicate that stereotactic psychosurgery is a safe and effective method of treating some medically intractable psychiatric illnesses.

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Section: Discussionmentioning

confidence: 99%

Review of Long-term Results of Stereotactic Psychosurgery.

Kim

Lee

Choi

2002

Neurol. Med. Chir.(Tokyo)

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“…127 Treatment response rates for each of these procedures ranges from 30% to 70%, with relatively minimal long-term side effects.…”

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confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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“…The patient believed the surgery to be a limbic leucotomy, a procedure performed at Atkinson Morley at that time [1]. However, that procedure entails two pairs of cerebral lesions, one pair placed in the cingulate area and the other in the ventromedial quadrants of the frontal lobes [2], which we did not see at imaging (Figure 2a).…”

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confidence: 65%

MR imaging of psychosurgery: rostral atrophy following stereotacic subcaudate tractotomy

Cauley¹,

Waheed

Salmela³

et al. 2010

BJR

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ABSTRACT. There are few reports of MR imaging findings following psychosurgery. Here, we report the findings of 3T MR imaging of the sequelae of stereotactic subcaudate tractotomy (SST). Rostral atrophy is noted on conventional imaging. Diffusion tensor (DT) tractography demonstrated no communicating white matter tracts between the inferior frontal lobes, which appeared normally as thick fibre bundles in age-matched controls. DT tractography provides a unique tool for the evaluation of sequelae of ablative psychosurgical procedures.

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Stereotactic Limbic Leucotomy: Neurophysiological Aspects and Operative Technique

Cited by 108 publications

References 19 publications

Review of Long-term Results of Stereotactic Psychosurgery.

Review of Long-term Results of Stereotactic Psychosurgery.

Deep brain stimulation for psychiatric disorders: where we are now

MR imaging of psychosurgery: rostral atrophy following stereotacic subcaudate tractotomy

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