Long-term Results of Stereotactic Psychosurgery

뇌정위적 정신수술의 장기 추적 결과

Objective : Stereotactic psychosurgery is known as one of effective means of treating in some medically intractable psychiatric illness. However, it is unfamiliar and it's long-term clinical result has not reported in our country. The authors evaluated its long-term results of pscychosurgery and discussed its neuroanatomical basis. Methods : Since 1993, eight patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses. All were referred from psychiatrist of these disorders, one was aggressive behavior, five were obsessive-compulsive disorders(OCD), and two were depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were done for aggressive behavior, and limbic leukotomy was done for OCD and depression with anxiety. The results of OCD were evaluated with with YBOCS(Yale-Brown obsessive compulsive scale) and VAS (visual analogue scale), CGI(clinical global impairment) in OCD, and OAS(overt aggression scale), MMS, WAIS were checked for the evaluation of aggressive behavior. Hamilton depression scale(HAMD) was used for evaluation of depression. Ventriculography was used in the first five patients and MR-guided stereotaxy was used in recent three cases for localization of target. The lesions were made with radiofrequency lesion generator. Results : With long-term follow up(mean 45 months) in five OCDs, mean YBOCS declined from 34 to 3(n=5). All returned to previous social life. In OAS scores of aggressive behavior during six-year follow up, scores declined from 8 to 2 with clinical improvement. In two patients with depression with anxiety, HAMD declined from 28.5 to 16.5(n=2). There was no operative mortality and no significant morbidity except one case of mild transient urinary incontinence. Conclusion : With these long-term results, authors assumed that stereotactic psychosurgery could be one of safe and effective mtherapeutic methods in several medically intractable psychiatric illness.