Stereotactic Operation in Behaviour Disorders. Amygdalotomy and Hypothalamotomy

Ramamurthi, B

doi:10.1007/978-3-7091-9005-0_29

Cited by 42 publications

(58 citation statements)

References 14 publications

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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%

“…In contrast, other clinical investigators 7,13,14,27,39 have targeted the anteromedial group of amygdaloid nuclei, and the central region of the amygdaloid nucleus has been targeted in only a limited number of clinical series. 1,2,34,40,45 Physiological confirmation of the anatomical target, by using intraoperative EEG monitoring alone or EEG monitoring together with olfactory stimulation by ether, has been performed in the majority of published clinical series. 1,2,7,14,27,33,34,40,[44][45][46] However, Heimburger et al 13 and Small et al 39 performed their procedures without electrophysiological monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,34,40,45 Physiological confirmation of the anatomical target, by using intraoperative EEG monitoring alone or EEG monitoring together with olfactory stimulation by ether, has been performed in the majority of published clinical series. 1,2,7,14,27,33,34,40,[44][45][46] However, Heimburger et al 13 and Small et al 39 performed their procedures without electrophysiological monitoring. Recent advances in neuroanesthesia may allow intraoperative electrical stimulation studies in awake patients undergoing stereotactic amygdalotomy not only to confirm the accuracy of the anatomical target, but also to define the exact part of the amygdaloid nuclei complex that must be lesioned.…”

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%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders

Mpakopoulou¹,

Gatos²,

Brotis³

et al. 2008

FOC

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“…6 One group from India presented results of amygdalotomy and hypothalamotomy in the treatment of refractory aggressive behavior. 7,74 One report published in 1975 included 49 patients who underwent PM hypothalamotomy, performed after failure of amygdalotomy in 33 cases. The results in the 8 cases in which primary bilateral PM hypothalamotomy was performed were considered "good."…”

Section: The Hypothalamus As a Stereotactic Target Lessons From The Pmentioning

confidence: 99%

The hypothalamus at the crossroads of psychopathology and neurosurgery

Barbosa

Oliveira‐Souza

Santo

et al. 2017

Neurosurgical Focus

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The neurosurgical endeavor to treat psychiatric patients may have been part of human history since its beginning. The modern era of psychosurgery can be traced to the heroic attempts of Gottlieb Burckhardt and Egas Moniz to alleviate mental symptoms through the ablation of restricted areas of the frontal lobes in patients with disabling psychiatric illnesses. Thanks to the adaptation of the stereotactic frame to human patients, the ablation of large volumes of brain tissue has been practically abandoned in favor of controlled interventions with discrete targets.Consonant with the role of the hypothalamus in the mediation of the most fundamental approach-avoidance behaviors, some hypothalamic nuclei and regions, in particular, have been selected as targets for the treatment of aggressiveness (posterior hypothalamus), pathological obesity (lateral or ventromedial nuclei), sexual deviations (ventromedial nucleus), and drug dependence (ventromedial nucleus). Some recent improvements in outcomes may have been due to the use of stereotactically guided deep brain stimulation and the change of therapeutic focus from categorical diagnoses (such as schizophrenia) to dimensional symptoms (such as aggressiveness), which are nonspecific in terms of formal diagnosis. However, agreement has never been reached on 2 related issues: 1) the choice of target, based on individual diagnoses; and 2) reliable prediction of outcomes related to individual targets. Despite the lingering controversies on such critical aspects, the experience of the past decades should pave the way for advances in the field. The current failure of pharmacological treatments in a considerable proportion of patients with chronic disabling mental disorders is reminiscent of the state of affairs that prevailed in the years before the early psychosurgical attempts.This article reviews the functional organization of the hypothalamus, the effects of ablation and stimulation of discrete hypothalamic regions, and the stereotactic targets that have most often been used in the treatment of psychopathological and behavioral symptoms; finally, the implications of current and past experience are presented from the perspective of how this fund of knowledge may usefully contribute to the future of hypothalamic psychosurgery.

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