Psychiatric amygdala destruction

The amygdala cluster is located in front of the anterior temporal lobe and at the anterior superior of the lateral ventricle. This large nucleus consists of a larger basolateral nucleus and a smaller cortical medial nucleus. Some people measured the front and rear pole distance of 12mm, the upper and lower pole distance is 16mm, the inner and outer pole distance is 13mm, the inner pole distance is 15mm, and the outer pole is 28mm from the center line. The amygdala cluster receives the outer olfactory fibers; the effervescent fibers are bent along the entire length of the caudate nucleus, called the terminal pattern, which is more than the olfactory region, the septum, and the hypothalamic anterior region. Making damaged lesions in the amygdala can make the mood stable, the temperament is gentle, and the aggression is reduced or disappeared. More need for bilateral surgery. Treatment of diseases: temporal lobe epilepsy schizophrenia Indication Psychiatric amygdala damage applies to: 1. Chronic schizophrenia with severe aggression, with a course of more than 3 years, and various non-surgical treatments are ineffective. 2. Brain dysplasia excitability enhancement. 3. temporal lobe epilepsy with severe behavioral disorders. 4. Paroxysmal anger (equivalent to explosive personality disorder) accompanied by abnormal discharge of amygdala. 5. Severe obsessive-compulsive disorder. 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. 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. 2. The skull hole is located 10cm above the eyebrow and 3cm next to the midline. It can also be accessed through the sacral scales. 3. Target coordinates: The amygdala is located in the anterior superior wall of the lower corner of the lateral ventricle and slightly protrudes into the ventricle. Therefore, the good indication of the lower corner is a guarantee of successful operation. The medial cortex of the cortex is 3 to 5 mm in front of the tip of the lower corner, 5 to 7 mm in the lower corner, and 15 to 18 mm in the sagittal midline. The basolateral nucleus is 8.3 mm in front of the lower corner tip, 7 mm in the lower corner, and 20 to 23 mm in the sagittal centerline. For example, the midpoint of the previous and post-joint line (AC-PC line) is the origin. The coordinates of the center point of the amygdala are: 8mm in front of the midpoint of the AC-PC line, 13.5mm below the midpoint of the sagittal line, and 21mm outward in the sagittal midline (Yao Jiaqing et al., 1983). ); or 2.5 to 3 mm behind the front joint, 15 mm below, and the sagittal midline outward 23 to 25 mm (Heimburger, 1978). 4. Before the damage, the electrical stimulation test produces respiratory depression or pause when stimulating the amygdala, which can help correct the position of the electrode. 5. The production of damaged stoves is mostly based on RF electric heating or freezing. It is advisable to destroy the size of the stove to a diameter of about 10 mm. complication Generally no complications. Patients with bilateral surgery occasionally have memory impairment, unstable walking, decreased sense of smell and hypersexuality, and are mostly temporary.