Use of surgical methods in correction of almost incurable psychic disorders: historical notes and state of the art

Gaidar B.V., Odinak M.M., Parfyonov V.E., Shamrey V.K.

(Chair of Neurosurgery, Chair of Nervous Diseases, Chair of Psychiatry, Medicomilitary Academy, Saint Petersburg, Russia)

Burckhardt G., a German psychiatrist (1891), was a pioneer of application of neurosurgery in the field of psychiatry. In Russia the first attempt of surgical correction of psychic disorders was made in the Medicomilitary Academy by Bekhterev V.M. and Pussep L.M. (1908). Results of these operations were dubious.

The growth of interest in psychosurgery began with fundamental research of Fulton J. (1935), who was a neurophysiologist. It served the basis for operations, performed Monis E. and Lima A. (1936). They consisted in transection of frontothalamic paths in psychic patients with brutal behavior and gave positive results. As for the USSR, accumulation of experience in performing such operations started at the end of the 1940s (Shmaryan A.S., Golant R.Ya., Luriya A.P., Goldenberg I., Gurevich M.O., Khvilivitsky T.Ya., Babchin I.S., Egorov B.G., Akhutin M.A., Koreisha L.I., etc.). Despite positive results research in this field was discontinued (by the Order of the USSR Ministry of Public Health, 1950) due to both subjective and objective causes. The latter were as follows: psychoorganic symptoms, watched in a half of patients in a remote period; advances of psychopharmacology; insufficient theoretical substantiation of indications; absence of sparing surgical approaches and necessary technical means for performing such operations. A revival of interest in these operations took place in the middle of the 60s, when the above problems had been solved to this or that extent or proved to be rather insufficient.

Today stereotactic interventions are performed in severe obsessional-compulsive disorders and the anterior third of the calossal convolution is considered to be the safest target (Ballantine H. et al., 1987; Guibert S., Renault C., 1897; Mindus P. et al., 1988; Shustin V.A. et al., 1991, 1997, etc.). At the same time there is information on effective use of neurosurgical methods (invasive and non-invasive) in complex therapy of a number of other almost incurable psychic disorders, including malignant forms of alcoholism and narcomania (Lutsik A.A., 1991; Anichkov A.D., Polyakov Yu.I., 2000). Solution on expediency of surgical treatment is made on the following basis: disease duration of not less than 3-5 years; a failure (high resistance) of all types of biological therapy; invalidism and resocialization of patients (conditioned by severity of a psychic disease); presence of a leading psychopathologic syndrome, related with known structures-targets.