The first person who performed psychiatric surgery in China should be said to be Professor Su, the old president of our hospital. He is having a frontal lobectomy. Moniz, the founder of the operation, cooperated with neurosurgeon Li Man to treat severe mental patients by surgical removal of white matter in frontal lobe, which was quite successful. Later, American psychiatrist Freeman and neurosurgeon Watta designed the "standard white matter amputation of the frontal lobe". From 1940 to 1955, more than 1000 people had this operation. According to Sargent's statistics, by 1962, there were 15000 psychiatric operations in Britain and 50000 in the United States. Moniz won the Nobel Prize in Medicine in 1949. However, it was later found that a considerable number of patients left some permanent sequelae after such operations, and their mortality and serious sequelae reached at least 6%. Some cases developed personality disorder or dementia after operation. The most famous thing is that Ross Kennedy, the sister of former US President Kennedy, accepted this operation, which was called "miracle effect" at that time, but she ended up living in a mental nursing home for life and could not lead a normal life at all. Many countries (such as the former Soviet Union and some states in the United States) have banned this operation. Although there is no explicit prohibition in China, no one has been engaged in this kind of treatment or research since the 1950s.
Over the years since the establishment of our hospital, many refractory cases of chronic schizophrenia have been' precipitated', and some of them have had many serious impulsive attacks and injuries, repeated treatment and repeated attacks. Finally, they had to be "protected" by leather handcuffs day and night, and were imprisoned in a single ward. From 65438 to 0975, I saw from foreign data that neurosurgery had developed stereotactic surgery; Foreign psychiatrists are also trying this method to treat refractory depression and obsessive-compulsive disorder. Some scholars have reported that the intractable impulsive behavior of schizophrenic patients will actually be improved after stereotactic surgery. So, I asked Professor Jiang Dajie, the pioneer of stereotactic surgery in neurosurgery in China at that time, and learned that stereotactic surgery and frontal lobectomy were not the same thing. After reporting to Professor Xia Zhenyi, approved by the leaders of the two hospitals, as a formal research topic, we cooperated with the neurosurgery department of Huashan Hospital to carry out the first stereotactic surgery for impulsive behavior of refractory schizophrenia in China. At that time, referring to foreign reports, the damaged targets were bilateral cingulate gyrus, amygdala and subcostal nucleus. The result was ideal, the leather handcuffs were lifted, and the case called "Tiger" was no longer impulsive and hurtful for no reason. But the mental symptoms have not been alleviated, even with antipsychotics, hallucinations and delusions have not been completely eliminated. Surgery 10 cases, all achieved similar results. The research achieved the expected effect, solved the treatment problem of severe impulsive attack, and won the scientific and technological progress award of Shanghai Health Bureau.
The news spread like wildfire and immediately set off a frenzy in psychiatry and neurosurgery in many hospitals across the country, and a large number of schizophrenics received psychiatric treatment. Some hospitals actually claim that there are thousands of people waiting for surgery outside the hospital. I remember one time, Professor Zhai Shutao and I appraised the results of their psychiatric surgical treatment in a hospital. According to their report, the mental symptoms disappeared as high as 85% after operation, but from the effective cases provided, it is hard to say that it is a standard schizophrenia. I exchanged views with Professor Zhai Shutao, and we came to the following conclusions: The National Psychiatric Association should set up a psychiatric cooperation group to standardize the research and treatment of psychiatry; In Professor Zhai's words, it is "not too hot, but some cold water should be poured".
19881110 held the first national symposium on psychosurgical treatment in ning in October, and established the national psychosurgical cooperation group, with Zhai Shutao and Xu Jianping as the team leaders and I as the deputy team leader. Because some norms have been formulated and brothers have been reminded many times to strictly grasp the indications of surgery, doctors who are keen on surgery gradually realize that the effect of surgery is not as ideal as originally imagined. This psychotic fever gradually cooled down from 1990. Of course, there are some normative studies, most of which are published in the Journal of Functional and Stereotactic Neurosurgery.
Looking around the world, foreign psychiatrists think that the curative effect on schizophrenia is not ideal, so no one has ever paid attention to the treatment of schizophrenia. For many years, it has been reported that the indications of psychosurgery are refractory depression and obsessive-compulsive disorder. Therefore, in the 1990s, I cooperated with Liu Jiannong, director of neurosurgery department of Suzhou Guangji Hospital, and tried to treat intractable obsessive-compulsive disorder with stereotactic bilateral cingulate gyrus destruction. I remember that the effect of 1 case was really encouraging. When the guide needle is inserted into the target position of the buckle bundle and RF heating is turned on, the patient's obsessive-compulsive symptoms disappear immediately. Surprisingly, the forced thinking that has made the patient suffer for many years will be completely relieved after the operation. To this end, we specially invited Professor Xia to visit this patient in Suzhou. Xia Lao suggested not to get too excited, but should be treated with caution and closely observe whether the curative effect is consolidated and whether there are any adverse reactions. Before and after treatment, we tried 23 cases, among which 18 cases improved in different degrees; But without exception, they all relapsed within 3 to 6 months and had to receive medication again. Fortunately, there are few adverse reactions of bilateral cingulate gyrus destruction, and only a few cases have temporary disturbance of consciousness and short-term urinary incontinence. I have also talked with American psychiatrists many times, and they feel the same way. Although the operation is effective, the recurrence rate is high. In some cases, even repeating the operation two or three times still can't solve the problem. Recently, I read a report that a unit used G knife to treat refractory obsessive-compulsive disorder, and it is said that the effect is ideal; But privately asked the doctors who cooperated with them, the curative effect was not consolidated, and most of them recurred.
As for the curative effect of psychiatric treatment on schizophrenia, there is no reliable and scientific follow-up and analysis in China so far. On the Internet, I saw that the dean of a hospital in Northeast China thought that the original reports on the recovery of patients with schizophrenia after surgery were all fictitious. Anyway, in the outpatient department, we can often see some cases with surgical scars on their heads, but they are still taking a lot of antipsychotics, and their mental symptoms have not been alleviated.
Recently, I saw some publicity materials on the Internet, and now some academic contents are summarized as follows: "The commonly used surgical methods are: cingulate gyrus destruction, internal capsule forelimb destruction, caudate nucleus conduction bundle amputation, posterior medial hypothalamus destruction and so on. Different surgical methods are suitable for different mental diseases: ① cingulate gyrus destruction is suitable for emotional mental disorders; ② Limb destruction of internal capsule is effective for obsessive-compulsive disorder, anxiety, social phobia and depression; ③ Subcaudal fasciotomy is effective for chronic recurrent depression, and it is also reported that it can treat obsessive-compulsive disorder. ④ Posterior medial hypothalamic nucleus destruction is mainly used to treat aggressive and destructive behaviors, sympathetic nervous tension and irritability. Among them, the significant improvement rate of internal capsule forelimb destruction in the treatment of obsessive-compulsive disorder reached more than 82%, and the quality of life was significantly improved. 93% patients stopped taking drugs. It also has a good curative effect on anxiety and depression, especially on panic, depression, suicidal tendency, hypochondriasis and physical symptoms, with the improvement rate above 60%. Some symptoms of chronic schizophrenia have also been significantly improved, mainly emotional response and behavioral disorders, soliloquy, unprovoked laughter and so on. Postoperative patients take less medicine and are easy to manage. ① The biggest surgical risk of cingulate gyrus destruction is epilepsy, and the short-term side effects include mild insanity, emotional damage and near memory impairment, and patients usually recover within a few weeks after operation. ② The effect of internal capsule forelimb destruction is better than cingulate gyrus destruction. The common side effects are short-term fatigue, insanity and near memory disorder, which usually recover within a few days. However, a few patients may have serious complications such as late engine loss, poor initiative and personality disorder. ③ The main side effects of subcostal fasciotomy are postoperative insanity and slight loss of speech and visual memory, which usually recover after several weeks to several months. ④ The destruction of posterior medial hypothalamic nucleus has slight side effects, and some patients have mild drowsiness, especially the delayed personality change, lack of interest and behavior disorder caused by the destruction of anterior limb of internal capsule. Although the incidence rate is below 5%, the cause and prevention methods are still unclear. "
On the whole, this propaganda material is honest, but it seems to exaggerate the curative effect. The short-term curative effect recognized abroad is only 30%, and the maximum is 68%; The risk of surgery is also reduced. It has been reported abroad that the incidence of postoperative epilepsy is at least 2.2%, and personality disorder may be as high as 6.7%. These operations were all the products of 30 years ago, 1970, and all of them damaged brain tissue. In fact, there is no reliable basis for the so-called "different surgical methods are suitable for different mental diseases" in the publicity materials. Why did you choose these targets at that time, just based on some animal research results. For example, when we choose to destroy the amygdala for impulsive attack, it is based on the experiment that cats are no longer irritable after the amygdala is destroyed. After the operation, the patient was gentle and stopped attacking others, which was actually a personality change caused by destructive surgery. But unfortunately, in the past 30 years, these aspects have not been further studied and improved.
Foreign neurosurgery and psychiatry have realized the serious defects of the destruction surgery, and turned their research interest to topics other than brain tissue destruction. For example, deep brain stimulation of DBS has shifted from treating Parkinson's disease to trying to treat refractory depression; But they are still limited to research, not as a formal treatment for depression or obsessive-compulsive disorder, which can be withdrawn at any time and restored to its original state. Recently, I read from the famous scientific magazine Nature (July issue) that a scientist placed electrodes in the motor area of the brain for a paraplegic patient, and recorded and interpreted the brain waves of one or more brain cells. Therefore, patients can move the mouse pointer on the computer screen according to their own ideas, so as to control the opening or closing of some instruments or living facilities (see attached figure). This is the real positive psychological surgery and research. I hope that doctors who are interested in psychiatry can broaden their horizons and turn their energy to more active psychiatric research. At the same time, it also calls on the relevant health leaders to pay attention to the corner of psychiatry, formulate operational norms in this regard, and actively guide and prevent unhealthy practices.
We should be soberly aware that psychosurgery is only a subject worthy of study after all, and it is not a formal treatment that can be engaged in a large number.