Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.
Brain Diseases ; Deep Brain Stimulation ; High-Intensity Focused Ultrasound Ablation ; Humans ; Neurosurgeons ; Obsessive-Compulsive Disorder ; Psychosurgery ; Psychotherapy ; Radiation Effects ; Radiosurgery ; Ultrasonography

History, 19th Century ; History, 20th Century ; Humans ; Neurology ; history ; Nobel Prize ; Philately ; Portugal ; Psychosurgery ; history ; methods

OBJECTIVE: There are a few reports on the complications of surgery for epilepsy. We surveyed our data to present complications of epilepsy surgeries from the neurosurgeon's point of view and compare our results with other previous reports. METHODS: A total of 179 surgical procedures for intractable epilepsy (41 diagnostic, 138 therapeutic) were performed in 92 consecutive patients (10 adults, 82 children) during the last 9.2 years (February. 1997-April. 2006). Their medical records and radiological findings were reviewed to identify and analyze the surgical complications. RESULTS: The diagnostic procedures encompassed various combinations of subdural grid, subdural strips, and depth electrodes. Four minor transient complications developed in 41 diagnostic procedures (4/41=9.8%). A total of 138 therapeutic procedures included 28 anterior temporal lobectomies, 21 other lobectomies, 6 lesionectomies, 21 topectomies, 13 callosotomies, 20 vagus nerve stimulations, 13 multiple subpial transections, and 16 hemispherectomies. Twenty-six complications developed in therapeutic procedures (26/138=18.8%). Out of the 26 complications, 21 complications were transient and reversible (minor; 21/138=15.2%), and 5 were serious complications (major; 5/138=3.6%). Five major complications were one visual field defect, two mortality cases and two vegetative states. There were 2 additional mortality cases which were not related to the surgery itself. CONCLUSION: Our results indicate that complication rate was higher than previous other reports in minor complications and was comparable in major complications. However, our results show relatively high frequency of mortality cases and severe morbidity case compared to other previous reports. The authors would like to emphasize the importance of acute postoperative care in young pediatric patients as well as meticulous surgical techniques to reduce morbidity and mortality in epilepsy surgery.
Adult ; Electrodes ; Epilepsy ; Humans ; Intraoperative Complications ; Medical Records ; Persistent Vegetative State ; Postoperative Care ; Psychosurgery ; Vagus Nerve Stimulation ; Visual Fields

OBJECTIVE: This study was designed to analyze seizure outcome and to investigate the prognostic factors for predicting seizure outcome according to the preoperative evaluations, surgical procedures, topectomy sites and histopathological findings in patients with extratemporal lobe epilepsy (ETLE). METHODS: This study comprised 63 patients with ETLE who underwent surgery. Preoperative evaluations included semiologic analysis, chronic video-EEG monitoring, and neuroimaging studies. Surgical procedures consisted of topectomy in 51 patients, corpus callosotomy in 9, functional hemispherectomy in 2, and vagus nerve stimulation (VNS) in 1. Histopathological findings were reviewed. Postoperative seizure outcomes were assessed by Engel's classification at the average follow up period of 66.8 months. Chi-square test was used for statistics. RESULTS: Total postoperative seizure outcomes were class I in 51 (80%) patients, class II in 6 (10%), class III in 6 (10%). Patients with structural abnormalities on neuroimaging study showed class I in 49 (88%) patients (p<0.05). Patients with focal and regional ictal EEG onset revealed class I in 47 (90%) patients (p<0.05). Semiologic findings, surgical procedures, topectomy sites and histopathological findings did not show statistical correlation with seizure outcome (p>0.05). CONCLUSION: A good seizure outcome was obtained in patients with ETLE. The factors for favorable seizure outcome are related to the presence of structural abnormalities on neuroimaging study, and focal and regional ictal EEG onset.
Classification ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Hemispherectomy ; Humans ; Neuroimaging ; Psychosurgery ; Seizures* ; Vagus Nerve Stimulation

OBJECTIVETo discuss the presurgical evaluation and surgical treatment of lesional temporal lobe epilepsy (LTLE).

METHODSWe retrospectively studied the patients whose MRI or CT showed lesions on one of the temporal lobes among patients who underwent epilepsy surgeries in our institute. All patients were divided into satisfactory and unsatisfactory group according to outcomes after operation. The characteristics of the lesions, neurophysiological features and results of pathologies were analyzed statistically.

RESULTFavorable surgical outcome was obtained in 24 patients, the satisfactory rate was 75%. The lesions of 17 patients were cortical malformations and the satisfactory rate of this group was 65%, which was less favorable than that of tumor group, (87%). 21 patients with their lesions located within the border of standard temporal lobectomy, had better surgical outcome than the others whose lesions were beyond the border (P<0.05). The satisfactory rate of 8 patients with lesions located within mesial structure of temporal lobe was no different compared with that of the others who had lesions outside the mesial structure (P>0.05). There were 19 patients who had consistency of the location of the lesion on MRI with the focal interictal epileptiform discharges on scalp EEG in satisfactory group, while there were only 3 patients in unsatisfactory group (P<0.05).

CONCLUSIONFor a LTLE patient, epilepsy surgery should be the first choice to be considered. Careful presurgical studies of the lesion, including its location, pathological property and neurophysiological characteristics, were very helpful for improving the surgical outcome.

Adolescent ; Adult ; Child ; Child, Preschool ; Epilepsy, Temporal Lobe ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Psychosurgery ; methods ; Retrospective Studies ; Temporal Lobe ; pathology ; surgery ; Treatment Outcome

Several case reports suggest that neurosurgical operations can improve symptoms in patients with severe treatment-refractory obsessive-compulsive disorder (OCD). However, it is unclear which procedure is best and which may produce the most side-effects. We also review recent ethical issues related to the procedures. We review the literature on the efficacy and complications of frequently used neurosurgical procedures that are used to treat refractory OCD and related ethical issues. Since the vast majority of patients who underwent surgery were severely and chronically disabled, it is likely that these procedure were of assistance in alleviating some of their symptoms. It is currently impossible to determine which surgical procedure is the best for a particular patient. Since the psychosurgery is reported as effective in the area of human behavior and psychopathology, the indication for operation demand strict ethical process. Recent studies report that strict informed consent and the evaluation for competence to decide whether to get operation with free will should be taken so as to stress the autonomy of patients for the treatment. Despite a lack of controlled data and inconsistencies in the literature, it appears that when nonsurgical treatments have failed to improve OCD symptoms significantly in severely ill patients, at least partial relief can be obtained by some people with OCD by neurosurgery. Results of cumulative studies strongly support the need for continued research in this area.
Ethics* ; Humans ; Informed Consent ; Mental Competency ; Neurosurgery ; Neurosurgical Procedures ; Obsessive-Compulsive Disorder* ; Personal Autonomy ; Psychopathology ; Psychosurgery

Despite a long and controversial history, psychosurgery has persisted as a modern treatment option for some severe, medically intractable psychiatric disorders. The empirical basis of psychosurgery is weak because of the lack of well-designed investigations. Several carefully conducted studies in which independent evaluation has been made, however, show convincingly that highly selective stereotactic operations on the brain can benefit some carefully selected, chronically ill psychiatric patients with a low rate of unwanted side effects. The goal of this article is to review the current state of psychosurgery. In this review, the definition of psychosurgery, patient selection criteria, and anatomical and physiological rationales for anterior cingulotomy, subcaudate tractotomy, anterior capsulotomy, limbic leukotomy, vagus nerve stimulation and deep brain stimulation are discussed.
Brain ; Chronic Disease ; Deep Brain Stimulation ; Humans ; Neurosurgery* ; Patient Selection ; Psychosurgery ; Vagus Nerve Stimulation

OBJECTIVE: An usefulness and an accuracy of Neurosurgery Simulator(R)(NSS(R)) is evaluated for the clinical applications. The NSS(R) is a surgical planning tool for stereotactic and functional neurosurgery, recently developed in Korea. METHODS: Thirty-four surgical cases, performed with the NSS(R) from October 1999 to April 2002, were analyzed. The accuracy was examined by comparing the actual lesion with the planned target. The usefulness was discussed with time consuming factor and convenience for surgical steps. Results of surgical outcome were also reviewed. RESULTS: The precise coordinates of surgical target is directly acquired by designating an anatomical lesion on the magnetic resonance image with NSS(R) due to auto recognition algorithm of the fiducials on the MRI image. The correctness is confirmed again by examining the anatomical lesion with superimposing the Schaltenbrand-Wahren atlas on the image directly. Among eleven cases of the thalamotomy for tremors, five cases resulted in complete resolution, the remaining five patients showed significant reduction of tremors. Improvement of ADL and UPDRS was recorded in all 6 Parkinson's disease patients who had undergone pallidotomy. Seventy five percent of patient in pain and psychosurgery resulted in improvements. The NSS(R) achieved 100% accuracy in calculating stereotactic biopsy coordinates. There was no deviation in guiding surgical trajectory. There was no significant surgical complication. CONCLUSION: Stereotactic and functional neurosurgery performed with the assistance of the NSS(R) is relatively safe and accurate.
Activities of Daily Living ; Biopsy ; Humans ; Korea ; Magnetic Resonance Imaging ; Neurosurgery* ; Pallidotomy ; Parkinson Disease ; Psychosurgery ; Tremor

No abstract available.
Psychosurgery*

The treatment consensus of anorexia nervosa in the last century was to remove the patient from her family and home surroundings. A great range of treatment from prescribing hormonal extracts to prefrontal leucotomy has been tried. Although in former decades many quite different forms of treatment have been described and advocated for anorexia nervosa, there is today consensus concerning the overall management of the disorder. But there still remains a widespread clinical opinion that inpatient treatment is necessary for some as a means of reliably increasing weight. Over the last hundred years the management of anorexia nervosa has changed. Treatment has shifted from medical wards, through to psychiatric wards and now, following the trends in all of medicine, towards community care in Western society. In Korea, case reports of anorexia nervosa and related articles have been published since the late seventies. Recently several epidemiological studies and clinical reports suggested increasing rate of eating disorders including anorexia nervosa in Korea. However, systematic approaches for these patients have not been tried in Korea. The author introduces the treatment model for inpatients with anorexia nervosa of Johns Hopkin's Hospital, Maudsley Hospital, and St. John's Mercy Medical Center. The author also introduces treatment experience with anorexic inpatient at Seoul Paik Hospital.
Anorexia Nervosa* ; Anorexia* ; Consensus ; Diethylpropion ; Feeding and Eating Disorders ; Humans ; Inpatients* ; Korea ; Psychosurgery ; Seoul