Psychiatric cingulate damage

The buckle is brought back to the inner side of the cerebral hemisphere, surrounding the body of the ear. The buckle belt is located inside the buckle belt, and the fiber is self-fastened and brought back to the front portion, and travels along the top of the body. The buckle back and the buckle belt bypass the body pressure and connect with the hippocampus and continue to move forward, almost reaching the bungee. The buckle belt effervescent fiber is divided into three parts, the dorsal radiation is connected with the iliac crest, the apex, and the occipital lobe; the ventral side is radiated through or across the corpus callosum to connect the striatum or the inner sac and the outer sac to the outer edge of the nucleus; Seahorse. There are also interactions with the hook bundle, the hippocampus, the amygdala cluster, the bungee cortex, the temporal region and the frontal cortex. The cingulate gyrus is associated with a wide range of fibers in the cingulate band and plays an important role in controlling behavior and emotional state in the marginal system. It is generally believed that the buckle belt destruction technique has a good effect on eliminating symptoms such as fear, depression, anxiety, tension and coercion. Both sides of the surgery are usually performed. Treatment of diseases: depression schizophrenia Indication Psychiatric buckle belt damage 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 sexual desire. 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. There are a variety of orientation guides installed. When installing, it is necessary to strictly follow the requirements of various types of orientation instruments and strive for standards. 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. The target area is located above the corpus callosum, and the anterior middle portion of the ligament is returned (equivalent to 1 to 4 cm behind the front end of the lateral ventricle). The target coordinates are as follows: (1) Ballantine method: 15 to 25 mm posterior to the anterior horn of the lateral ventricle, upper plane of the anterior horn of the lateral ventricle, 8 mm to the sagittal midline; or 20 to 40 mm posterior to the anterior horn of the lateral ventricle. ~10mm, the sagittal midline is 5-10mm outward. (2) Paniagna method: 30-40 mm posterior to the anterior horn of the lateral ventricle, 20 mm above the lateral ventricle; 5 mm to the sagittal midline; or 30 to 40 mm posterior to the anterior horn of the lateral ventricle, 10 mm above the lateral ventricle. The sagittal midline is 5mm outward. (3) Levin method: 40 mm posterior to the anterior horn of the lateral ventricle, the upper edge of the lateral ventricle (positive position) is destroyed by three points from the bottom to the top, with a spacing of 3 mm and a sagittal midline of 6 mm. (4) Multi-point destruction: The first point of the anterior slice is selected outside the anterior horn of the lateral ventricle, 5 mm above the ventricle, and the lateral piece is located 30 mm behind the front end of the front corner; the second point is 8 mm inside the first point. . Select the corresponding two points at 12mm before the two points, and destroy 4 points on each side. Deep and shallow lesions can also be made in each target area. The first one is located 1cm above the top of the lateral ventricle, then the electrode is pulled out 1cm, and a lesion is made 2cm above the top of the lateral ventricle. 3. The production of damaged stoves is mostly based on RF electric heating or freezing. The diameter of the damaged lesion is preferably 10-15 mm. 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.