2005, Number 2
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Med Sur 2005; 12 (2)
Current status of radiosurgery with Gamma Knife in Mexico
Valle R, Anda S, Ruiz S, Patarroyo C, Ruiz I, Garnica R, Rosales J, Rocha M, López D, Aviña C, Arreola F, Rochín G, Enríquez N, Diaz R, Paz CM, Aguilar E, Pérez-PastenesM, Ortiz J, José Jaramillo J, Hernández E, Gómez E, Estrada J, Rojas A
Language: Spanish
References: 44
Page: 99-108
PDF size: 185.32 Kb.
ABSTRACT
Today, psychosurgery is a minimally invasive highly selective treatment that is performed on only a few patients with severe, treatment refractory, affective, anxiety, or obsessive-compulsive disorders. Recent advancements in technology and functional neuroanatomy as well as economic pressures to lower the cost of caring for the chronically ill may provide an opportunity for psychosurgery to become a more attractive option in the treatment of psychiatric disease. In recent years, the rapid adoption of computer-based techniques for surgical planning and visualization and image-guided surgery has made possible a number of impressive advances in functional neurosurgery. Magnetic resonance imaging (MRI) allows the acquisition of highly detailed structural information about the soft tissues of the brain. Minute pathological alterations can be visualized, even before they can be detected by other means. Stereotactical atlases based on this information are now used to achieve an exquisite precision of location of the electrodes and probes and for planning the operation. Functional imaging is also now possible utilizing special metabolic markers and MRI, and computerized techniques for mathematical processing and visualization of the images. In this way, non-invasive evaluation of brain function can be performed with extraordinary precision and sensitivity. Stereotactic surgery without opening the skull and without blood (even the patient´s head doesn´t need to be shaved) is possible with a revolutionary technique called radiosurgery. The destruction of nervous or vascular tissue inside the brain is achieved by projecting thin and powerful beams of ionizing radiation, coming from several angles around the patient´s head. They are produced by sources of radioactive cobalt (the “gamma Knife”, developed in the 60s by the Swedish neurosurgeon Lars Leksell). In this way, radiation energy concentrates into a single, small point inside the brain. Gamma Knife radiosurgery started in our Country in 1996 in order to treat patients diagnosed with psychiatric diseases who were treatment refractory. Achieving this requires multidisciplinary effort of psychiatrists, neuropsychologists, neurologists, neurosurgeons and medical physicists, in accordance with the psychiatric neurosurgical protocol and ethics code of Medica Sur as well as with the guidelines established by the National Nuclear Regulatory Commission and the guidelines of the section of radiosurgery and stereotactic radiotherapy of the Mexican College of Neurological Surgery. Nine patients have been treated with several procedures as cingulotomy, anterior capsulotomy, subcaudate tractotomy and limbic leucotomy in order to aid obsessive-compulsive disorder, major depression, pathological aggressivity, Asperger and Tourette Syndrome. In this paper we disclose our experience with follow ups ranging from six months to seven years in accordance with the most usual evaluation scales for mental disease and multiaxial evaluation framework of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
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