Posteromedial Hypothalamotomy Research Articles

La moderna psicocirugía: un nuevo enfoque de la neurocirugía en la enfermedad psiquiátrica

To obtain an up to date review of the different possible surgical approaches in the management of certain psychiatric disorders that are refractory to conservative treatment (pharmacotherapy, psychotherapy, electroconvulsive therapy). In order to conduct this research we reviewed the work published by centres with the most experience in this type of surgery, mainly in North America and Europe, since its beginnings in the 1930s, with the controversy concerning prefrontal leucotomy, until the appearance of modern stereotactic techniques. We analyse the anatomophysiological bases, their main clinical indications, the surgical techniques used and their results, as well as perspectives for the future of this neurosurgical treatment. The most noteworthy progress in psychosurgery in recent years has been the combination of a more rigorous selection of patients and the higher degree of specificity with which treatment is performed on the brain structures involved in psychiatric disease. The most widely employed psychosurgical procedures at present are cingulotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy and postero medial hypothalamotomy, with favourable responses in about 35 70% of cases. The psychiatric diagnoses where the best results are to be found are obsessive compulsive disorder, chronic anxiety states and major depression. Current progress in neuroimaging techniques, increased neurophysiological knowledge and the revolutionary neuromodulation techniques, especially deep brain stimulation, offer an even more promising future for psychiatric neurosurgery.

Psychosurgery

The author describes the three commonly practiced surgical methods in the treatment of mental illness, i.e., cingulotomy, anterior capsulotomy, and posteromedial hypothalamotomy

Posteromedial hypothalamotomy in the treatment of violent, aggressive behaviour.

Although emotion in the human is largely modified by the frontal association areas (software) and may better be called affect, it is still very much influenced by the balance of the ergotropic and the trophotropic circuits in the prosencephalon (hardware) especially in patients with organic brain lesions. Violent, aggressive, restless behaviours or rage can be regarded as an unbalanced state of these two circuits with dominance of the ergotropic circuit. In order to restore the balance of these two circuits, small stereotactic lesions were made in the ergotropic portion of the posterior hypothalamus (posteromedial hypothalamotomy) with good results in the follow-up of 10-25 years. Postoperatively there was no disturbance in endocrine activities and growth.

Psychosurgery today.

A review on indications, target points and results of stereotactic operations for treatment of psychiatric diseases is given, based on personal experiences and reports in the literature. As a conclusion the author suggests that the anatomical target should be chosen selectively. There is strong evidence that different approaches lead to different results. Cingulotomy is effective for chronic pain with addiction and depression, anterior capsulotomy for obsessive-compulsive and anxiety neurosis, innominotomy for chronic and recurrent depression, and postero-medial hypothalamotomy for restless, aggressive and destructive behaviour. Therefore, the target should be selected according to the individual symptoms of the patient. The results of operation are usually good and most patients can return to a normal life. The side-effects are infrequent and seldom serious. Modern psychosurgery does not modify the personality of the patient. On the contrary it often relieves it from disturbing symptoms of illness.

CT-guided ablative stereotaxis without ventriculography.

A new technique is described which permits all types of stereotactic surgery to be done without ventriculography, with CT guidance only. The present series consists of 42 patients who underwent thalamotomy, posteromedial hypothalamotomy, dentatotomy or anterior capsulotomy for movement disorders, chronic pain, spasmodic torticollis or psychiatric illness. Postoperative lesion control with repeated CT showed that the method was accurate. The clinical results were considered to be better than those after previous ventriculography-guided surgery. It is concluded that ventriculography is no longer needed for stereotactic neurosurgery.

Relief of intractable pain from neurosurgical point of view with reference to present limits and clinical indications --a review of 100 consecutive cases--.

One hundred cases of intractable pain treated with various neurosurgical procedures were reported. These 100 cases consisted of 30 cases of percutaneous cordotomy, 21 cases of posteromedial hypothalamotomy, 2 cases of rostral mesencephalic reticulotomy and 47 cases of centromedian-parafascicular (CM-Pt) thalamotomy. Clinical results of pain relief by these procedures were discussed with reference to present limits and clinical indications. Based on these clinical data, a proposal was made for new concept of pain perception.

Posteromedial Hypothalamotomy in the treatment of tractable pain,.

Posteromedial Hypothalamotomy in the treatment of tractable pain,.

S-I-3. The Posteromedial Hypothalamotomy for the Treatment of Behavior Disorders

S-I-3. The Posteromedial Hypothalamotomy for the Treatment of Behavior Disorders

Postero-medial hypothalamotomy in the treatment of aggressive behaviors.

Postero-medial hypothalamotomy in the treatment of aggressive behaviors.

Sedative Stereoencephalotomy: Fornicotomy, Upper Mesencephalic Reticulotomy and Postero-Medial Hypothalamotomy

This chapter describes the different aspects of fornicotomy, upper mesencephalic reticulotomy, and postero-medial hypothalamotomy. Disorders of emotion as manifested in aggressive behavior or attacks of rage are most difficult to handle from medical as well as social point of view. The trophotropic zone of the hypothalamus including the preoptic area, the posterior orbital area, the insula, the uncus, the amygdala and the other paleocortical areas constitute the trophotropic circuit. The hippocampal formation and the fornix may be regarded as the common axis of these two circuits. It is found that fornicotomy was effective mostly in the epileptic personality changes, that is, irritability and aggressive behavior developed in the course of repeated convulsive seizures. In these cases, irritative foci were probably formed in the temporal lobe, especially in the hippocampal region, as the result of seizures, and these foci may have bombarded the hypothalamus through the fornix. It is observed that electrographic changes were recorded by means of the needle inserted into the posteromedial hypothalamus and implanted electrodes in other areas, such as the hippocampus, the amygdala, the temporal and the frontal cortices, and the anterior hypothalamus and the thalamus.