Stereotaxic Amygdalotomy for Epilepsy With Aggressive Behavior

Heimburger, Robert F.

doi:10.1001/jama.1966.03110200097026

Cited by 83 publications

(30 citation statements)

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“…Later, however, this method was abandoned, and the cryoprobecreated lesions were replaced with mechanical lesions, which were more precise from an anatomical standpoint and had a smaller volume. 39 Heimburger and colleagues 13 reported that 35% of their patients became free of any behavioral abnormalities and that 45% of them had significant improvement. Similarly, Balasubramaniam and Ramamurthi 4 reported on a large clinical series of 100 patients who had undergone bilateral stereotactic amygdalotomy for assaultive, hyperkinetic, destructive, self-destructive, or pyromaniac behavior.…”

Section: Resultsmentioning

confidence: 98%

“…Procedures were performed in all 58 patients after the application of a local anesthetic. The surgical technique was the same as that described by Heimburger et al, 13 whereas the anatomical target was centered in the anteromedial part of the amygdaloid nucleus. 39 Intraoperative EEG monitoring was available in most cases.…”

Section: Resultsmentioning

confidence: 99%

“…Since that initial report, there have been Ͼ 500 reported cases of stereotactic amygdalotomy for various behavioral disturbances and epilepsy, with varying results. 10,12,13,15,18,20,21,26,27,30,31,39 Different surgical approaches have involved various stereotactic devices and modalities for amygdaloid nucleus destruction, such as the injection of alcohol, oil, kaolin, or wax; cryoprobe lesioning; mechanical destruction; diathermy loop; and radiofrequency lesioning. 1,9,12,14,16,20,25,38 During the past 3 decades, however, advances in neuropharmacology along with the practical banning of psychosurgery have led to a significant decrease in the number of amygdalotomies performed around the world.…”

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confidence: 99%

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Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders

Mpakopoulou¹,

Gatos²,

Brotis³

et al. 2008

FOC

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Object Stereotactic amygdalotomy has been utilized as a surgical treatment for severe aggressive behavioral disorders. Several clinical studies have been reported since the first description of the procedure. In the current study, the authors reviewed the literature and evaluated the surgical results, neuropsychological outcome, and complication rate in patients who had undergone stereotactic amygdalotomy for severe aggressive behavioral disorders. Methods The PubMed database was searched using the following terms: “amygdalotomy,” “amygdalectomy,” “amygdaloidectomy,” “psychosurgery,” “aggressive disorder,” and “behavioral disorder.” Clinical series with more than 5 patients undergoing stereotactic amygdalotomy for aggressive or other behavioral disorders were included in this review. The surgical technique, anatomical target, improvement in psychiatric symptomatology, postoperative employment and social rehabilitation, postoperative neurocognitive function, procedure-related complications, and long-term follow-up were evaluated. Results Thirteen clinical studies met our inclusion criteria. Reported postoperative improvement in aggressive behavior varied between 33 and 100%. Procedure-related complication rates ranged from 0 to 42%, whereas the mortality rate was as high as 3.8%. In the majority of the reviewed clinical series, the performance of stereotactic amygdalotomy did not compromise a patient’s learning, language, and intellectual capabilities. The long-term follow-up, although very limited, revealed that initially observed improvement was maintained in most cases. Conclusions Stereotactic amygdalotomy can be considered a valid surgical treatment option for carefully selected patients with medically refractory aggressive behavioral disorders. Recent advances in imaging and stereotactic navigation can further improve outcome and minimize the complication rate associated with this psychosurgical procedure.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders

Mpakopoulou¹,

Gatos²,

Brotis³

et al. 2008

FOC

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“…Over a 1-11 year follow-up period, seizures were 'improved' in 50%, with psychomotor seizures responding the best. 10 Vaernet 11 reported the results of amygdalotomy in 45 patients with temporal lobe epilepsy followed for more than one year. Of 27 patients undergoing unilateral amygdalotomy for a unilateral focus, five became seizure-free and 10 experienced greater than 50% reduction of seizure frequency; with bilateral amygdalotomies in four patients with bilateral foci, two were seizure-free and two significantly improved.…”

Section: Stereotactic Amygdalotomy Hippocampotomymentioning

confidence: 99%

“…Bilateral lesions confined to the amygdala have been shown to be safe from a neuropsychologic standpoint, and may be useful in this group of patients. 10,11,17,19 3. Similarly, patients who have undergone temporal lobectomy and continue to experience seizures from the contralateral temporal lobe might be considered for lesioning of the remaining amygdala.…”

Section: Stereotactic Lesioning In the Medial Temporal Lobe Hasmentioning

confidence: 99%

Stereotactic Surgery for Temporal Lobe Epilepsy

Parrent

Lozano²

2000

Can J Neurol Sci.

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There has been a resurgence of interest in stereotactic procedures for epilepsy and functional neurosurgical disorders. There are several factors responsible for this. The most important is the significant improvement in brain imaging which has come as a consequence of the development of computerized tomography and, in particular, magnetic resonance imaging (MRI). T h e s e procedures have improved the spatial definition and resolution of imaging and have made image-guided surgery easier, more accurate and more accessible to mainstream neurosurg e r y. T h e improvements in imaging have worked in concert with an increased understanding of the pathophysiology of epilepsy disorders such that the identification and selection of targets has a stronger scientific rationale than was previously available. In addition to these important developments, there is a large historical basis for the use of stereotactic procedures in the treatment of epilepsy with some interesting if not promising initial results.Finally the general trend towards minimally invasive surgery is responsible for the need to re-examine stereotactic procedures. With the trend towards minimizing surgical exposure and patient discomfort and shortening hospital stay, there will be a further need to re-examine the use of stereotactic functional procedures. ABSTRACT:In light of the recent resurgence of interest in stereotactic functional procedures, the authors have reviewed the role of stereotactic ablative surgery in the treatment of temporal lobe epilepsy. Literature pertaining to stereotactic amygdalotomy, hippocampotomy and fornicotomy is reviewed and summarized. However, the results presented in those early studies are difficult to interpret given the surgical techniques and outcome assessment used. Modern stereotactic ablative surgery using current image-guided technology offers the opportunity to revisit some of these techniques. In recent studies of stereotactic amygdalohippocampotomy, outcomes are not as favorable as those obtained with standard temporal resections. However, these relatively discrete ablative techniques may shed light on the anatomical substrate underlying temporal lobe epilepsy.RÉSUMÉ: La chirurgie stéréotaxique dans l'épilepsie temporale. Dans l'optique d'un regain récent d'intérêt pour les procédures fonctionnelles stéréotaxiques, les auteurs ont revu le rôle de la chirurgie ablative stéréotaxique dans le traitement de l'épilepsie temporale. La littérature concernant l'amygdalotomie stéréotaxique, l'hippocampotomie et la fornicotomie est revue et résumée. Cependant, les résultats présentés dans les études antérieures sont difficiles à interpréter compte tenu des techniques chirurgicales et des moyens d'évaluation des résultats utilisés. La chirurgie ablative stéréotaxique moderne utilisant la technologie sous guidage par imagerie offre l'occasion de revoir certaines de ces techniques. Dans les études récentes de l'amygdalohippocampotomie stéréotaxique, les résultats ne sont pas aussi favorables que ceux obtenus par les résecti...

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A Contemporary View of Psychosurgery

Bridges¹

1978

Current Themes in Psychiatry 1

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Stereotaxic Amygdalotomy for Epilepsy With Aggressive Behavior

Cited by 83 publications

References 5 publications

Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders

Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders

Stereotactic Surgery for Temporal Lobe Epilepsy

A Contemporary View of Psychosurgery

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