ablative neurosurgery 消融神经外科

介绍：

“Modern ablative neurosurgical procedures are stereotactically guided, resulting in small and accurately placed lesions. This is most commonly achieved using thermal stimuli, although there is ongoing research into the use of radiosurgical techniques such as the gamma knife.” (“New oxford textbook of psychiatry”, 2020, p. 1019)
现代的消融神经外科手术是在立体定向引导下进行的，产生的病灶小且定位准确。这通常是使用热刺激来实现的，尽管目前正在研究使用伽玛刀等放射外科技术。
“Anterior cingulotomy, involving lesions placed in the dorsal anterior cingulate cortex, and anterior capsulotomy, involving lesions placed within the inferior fronto-thalamic connections within the anterior limb of the internal capsule, are the most common procedures. Both are hypothesized to modulate functioning within the corticostriatal-thalamic circuitry. The available evidence suggests that neurosurgery produces significant therapeutic benefits to 30–60% of patients with otherwise highly refractory OCD. Serious adverse effects are uncommon but have been reported with both procedures (for example, intracranial haemorrhage, recurrent seizures). Anterior cingulotomy appears to offer a superior safety profile to that of anterior capsulotomy. The quality of evidence supporting each procedure is reflective of neurosurgery as a whole. A  single RCT of gamma capsulotomy has been performed in 16 highly refractory patients . There was a non-significant benefit on the Y-BOCS for the actively lesioned group. The most serious adverse event was a single asymptomatic radiationinduced cyst. Surgical intervention is reserved for patients with severe, incapacitating OCD who have failed an exhaustive array of expertly delivered medication trials and intensive evidence-based CBT.” (“New oxford textbook of psychiatry”, 2020, p. 1019)
扣带前回毁损术是最常见的手术，病变位于前扣带回背侧皮质，前囊膜切开术是最常见的手术，病变位于内囊前肢的下额-丘脑连接处。两者都被假设调节皮层-丘脑环路内的功能。现有证据表明，神经外科手术对30 % ~ 60 %的难治性强迫症患者有显著的治疗获益。严重的不良反应是罕见的，但两种程序都有报道。扣带前回毁损术似乎提供了优于前囊膜切开术的安全性。支持每一项操作的证据质量是神经外科整体的反映。在16例高度难治患者中进行了单次伽玛刀治疗的RCT。对于活动性病变组，Y – BOCS评分无显著改善。最严重的不良事件为单个无症状放射性囊肿。手术干预是为那些未能完成一系列专家提供的药物试验和强化循证CBT的严重、无行为能力的OCD患者。