Stereotactic Amygdalotomy for Convulsive and Behavioral Disorders

Heimburger, Robert F.; Small, Iver F.; Small, Joyce G.; Milstein, Victör; Moore, Donald F.

doi:10.1159/000102399

Cited by 21 publications

(16 citation statements)

References 5 publications

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“…The method of patient selection and assessment, surgical approach, the specific amygdalar nuclei targeted for the procedure, and the size of the lesions created have varied across operators, making direct comparison of outcomes difficult [48]. Generally, the patients treated are described has having less aggressive behavior and a reduction in hyperactivity [48][49][50][51]. Posterior medial hypothalamotomy also has been done alone or in combination with amygdalotomy, for the treatment of aggression [49,52,53].…”

Section: Intractable Aggressionmentioning

confidence: 99%

Neurosurgical interventions for neuropsychiatric syndromes

Anderson

Arciniegas

2004

Curr Psychiatry Rep

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Psychosurgical procedures have been used for the treatment of intractable mental illness for more than 50 years. With improvements in surgical techniques, including new implantable stimulators, advances in functional neuroimaging, and progress in our fundamental understanding of the pathophysiology of mental illness there is a renewed interest in neurosurgical treatment of refractory psychiatric illness. This article will review the history of psychosurgery and recent developments in surgical techniques and implantable devices used in this context. The results of psychosurgery for the treatment of several psychiatric conditions and neuropsychiatric symptoms will be presented, including obsessive-compulsive disorder, Tourette's syndrome, depression, anxiety, aggression, self-injurious behavior, and schizophrenia. Lastly, a perspective on the current and future role of psychosurgery for the treatment of mental illnesses will be discussed.

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Section: Intractable Aggressionmentioning

confidence: 99%

Neurosurgical interventions for neuropsychiatric syndromes

Anderson

Arciniegas

2004

Curr Psychiatry Rep

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“…[1][2][3][4][5]7,[12][13][14][15]24,26,[32][33][34]39,40,45,46 It must be emphasized that a comparison of the results of these series is meaningless given the nonhomogenous populations studied, the differences in the surgical technique applied, and the significantly varying outcome criteria. It has been demonstrated that the amygdala in humans consists of 23 distinct subnuclei, which have been identified.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of procedure-related complications has varied significantly among published clinical series. [1][2][3][4][5]7,[12][13][14][15]24,27,[32][33][34]39,40,[44][45][46] Hitchcock and Cairns 14 reported no procedure-related complications and no postoperative impairment in the intellectual functioning of their patients. Similarly, Balasubramaniam and Ramamurthi 4 reported no postoperative cases of Klüver-Bucy syndrome, memory deficits, or hypersexuality.…”

Section: Discussionmentioning

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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“…Three patients became seizure-free and four experienced significant reduction in seizure severity and frequency. Heimburger et al 9 performed amygdalotomy in 58 patients for control of seizures and/or behaviour disorders. Seizures were described as psychomotor, petit mal and grand mal.…”

Section: Stereotactic Amygdalotomy Hippocampotomymentioning

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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Stereotactic Amygdalotomy for Convulsive and Behavioral Disorders

Cited by 21 publications

References 5 publications

Neurosurgical interventions for neuropsychiatric syndromes

Neurosurgical interventions for neuropsychiatric syndromes

Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders

Stereotactic Surgery for Temporal Lobe Epilepsy

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