Surgical Experience of Stereotactic Psychosurgery for Psychiatric Diseases

ABSTRACT

The authors report surgical experiences in patients with severe psychiatric illness refractory to all other conventional treatments. All 5 patients in this series were referred from their own psychiatrists. One patient with aggressive-conductive disorder, who was cared for in a closed ward, underwent bilateral amygdalotomy and bifrontal leucotomy. Four patients with obsessive-compulsive disorder were treated by limbic leucotomy, which is a combination of subcaudate tractotomy and anterior cingulotomy. Target points were selected according to the individual symptoms of each patients. Target construction was performed under ventriculogram or computerized tomographic guidance, using a Hitchcock stereotactic frame. All the procedures were performed under local anesthesia, except for the patient with aggressive-conductive disorder for whom the surgery had to be performed under general anesthesia because of the incooperative nature of the patient. The result of each surgery was good without serious complication. During the follow-up period, all the patients were freed from disturbing symptoms and successfully returned to their premorbid social life. Psychosurgery can be helpful in certain patients with severe, chronic, disabling, and treatment-refractory psychiatric illness.