Surgical correction in some neurologic and psychic disorders
(Department of Surgical Treatment of Nervous and Psychic Diseases, Bekhterev Psychoneurologic Research Institute, Saint Petersburg, Russia)
Methods of surgical correction of some neurologic and psychic diseases should be regarded as a link in the system of treatment and
rehabilitation. A forcible argument in choosing surgical correction is a failure of the whole complex of medicamental and other conservative methods of treatment.
However, exhausted conservative therapy is a term, whose boundaries should be defined more exactly.
A modern spectrum of surgical methods includes:
- Open operations (epilepsy with a various degree of psychic disorders; infantile cerebral paralysis with spastic syndrome, etc.);
- Stereotactic operations as the most sparing method, ensuring exact local impacts on different cerebral structures (parkinsonism, hyperkinesis, epilepsy, numerous psychic disorders, including narcomania);
- Shunting operations, providing liquor outflow from cerebral ventricles into other cavities of the body with the help of special systems (dementia against a background of hydrocephalus with Hakim-Adams' syndrome, etc.);
- Transplantation of embryonal (fetal) nervous tissue, performed during open operations or with the help of a stereotactic method (parkinsonism, epilepsy, mental retardation, hyperactivity syndrome, other psychic disorders);
- Chronic electrostimulation of the 10th cranial nerve (epilepsy);
- Chronic electrostimulation of thalamus (hyperkinesis);
- Radiation stereotactic surgery is characterized by different technique and can be used in a broad range of neurologic and neurosurgical diseases; it is highly effective and allows to avoid open operations.
Our experience of surgical treatment of patients, the majority of whom had psychic disorders, is as follows: 8 out of 350 patients with
epilepsy underwent extended operations; 24 patients with obsessional-compulsive disorders and Turett's disease were subject to stereotactic operations;
transplantation of embryonal nervous tissue was made in 12 patients; shunting operations were used in 3 cases. Efficacy of treatment is about 70%.