Stereotactic neurosurgery in complex treatment of patients with opiate abuse

Anichkov A.D., Polyakov Yu.I.

(Institute of Human Brain of the Russian Academy of Sciences, Saint Petersburg, Russia)

Opiate abuse is a chronic disease, whose treatment entails great difficulties. It is connected with quick formation and extremely difficult elimination of the so-called psychic dependence. Many authors consider a syndrome of psychic dependence to be a phenomenon, which is very close to a group of obsessional-compulsive syndromes (OCS). Thus, we made an attempt to use a stereotactic method, known as bilateral cryocingulotomy (it is the most widespread type of operations for OCS) in multimodality therapy of patients with opiate abuse.

During 1998-2000 we operated 210 patients with opiate abuse, resistant to conventional therapy. A period of narcotization was up to 15 years; a daily dose of heroin varied from 0.2 up to 1.5 g; 55 patients were examined a year after the operation. The results were as follows:

There were no side effects in psychic and somatic areas.

Comparison of efficacy of conventional methods (5-10%) and complex treatment of narcomania with bilateral cryocingulotomy is indicative of adequacy of an approach and necessity of further research in this field.

The study, carried out by us, shows, that bilateral stereotactic cryocingulotomy can become an effective additional means of control of an obsessional-compulsive component of a pathologic inclination in patients with opiate dependence. However, it should be used in a complex of measures of pharmacologic and social-psychological rehabilitation.