Psychiatric multi-target ablation

Treatment of diseases: depression anxiety Indication Psychosis multi-target destruction is applicable to: 1. Chronic schizophrenia with affective disorder and/or impulsive aggression, which is ineffective after long-term psychotherapy, drug therapy and electroconvulsive therapy. 2. Affective psychosis and various types of neurosis, such as chronic depression, anxiety, stress and obsessive-compulsive disorder, phobia. However, this type of patient responds well to drugs and/or electroconvulsive therapy and can alleviate spontaneously. Surgery is limited to a few severe cases with prolonged prolongation. Contraindications 1. It is strictly forbidden to use surgery for people with mental illness and libido; 2. Symptomatic psychosis, accompanied by obvious mental retardation and severe brain regression. 3. Older age and those with severe physical illness. Preoperative preparation In addition to the full physical examination and various tests before surgery, you should do EEG, CT and other auxiliary examinations, and do intelligent and memory tests, using the mental illness scale to record changes in the condition. These tests are best performed by a psychiatrist before and after surgery and independently evaluated. Whether it is suitable for surgery is decided by a psychiatric and neurosurgical discussion. Surgical procedure Anesthesia and position General anesthesia is generally used, supine position, and sitting position. Surgical procedure 1. Install the orientation meter There are a variety of orientation meters, and the installation should be strictly in accordance with the requirements of various types of orientation instruments, and strive to standard. For example, Bintian Orientation, the patient's head position must be adjusted so that the earplugs on both sides of the frame are aligned with the external auditory canal, and the midline of the skull is aligned with the center hole before and after the frame (ie, the instrument centerline). The Leksell directional instrument must be installed with the sagittal midline of the frame coincident with the midline of the skull. The Y axis of the frame is parallel to the GI line. The head in the anteroposterior direction is located at the center of the frame, avoiding the frame reclining, leaning forward or rotating, and eliminating positioning errors as much as possible. The forehead hole is located 9 to 10 cm above the eyebrow and 1.5 cm from the midline. 2. Target selection The cingulate gyrus, the amygdala and the caudate nucleus are the main target structures for the treatment of psychosis, and can be used in various combinations. For example, under the nucleus of the nucleus with a buckled band destruction; under the caudate nucleus plus amygdala destruction; amygdala plus buckle band destruction; amygdala plus caudate nucleus under the buckle with a bundle of damage. The coordinates of the target area under the caudate nucleus are: 1Knight method: 4 mm before the saddle nodule, 15 mm above the sphenoidal plate, 10 mm from the midline. 2Broseta method: 10mm in front of the base of the anterior bed, 10mm, 30mm above the base of the anterior cranial fossa, 16mm from the midline. complication Occasionally, unilateral or bilateral sputum (mainly in the foot or lower limb), urinary incontinence, are temporary, may involve the destruction of the anterior cerebral artery branch, or the central lobule, lower limb and foot movement area affected by edema reaction To. If the position of the damaged lesion is too late, it may cause slow response, reduced movement and mutism.