"rối loạn tâm thần phân liệt không tình cảm" tại Ban Geoffrey Knight tại London. Trong số những bệnh nhân trải qua subcaudate tractotomy, 40-60% tiếp tục sống cuộc sống bình thường hoặc gần bình thường. Ngoài ra, họ cũng đã chứng minh rằng tỷ lệ tự tử đã giảm 1% postoperatively, | Neurosurgical Treatments 345 Fig. 5. Diagram by P. D. Malone of Lahey Clinic of bimedial approach. Reprinted with permission from ref. 59. was the risk that the implanted seeds could migrate. Bridges et al. 18 published a retrospective report of nearly 1300 patients with non-schizophrenic affective disorders at The Geoffrey Knight Unit in London. Of patients who underwent subcaudate tractotomy 40-60 went on to live normal or near normal lives. Additionally they also demonstrated that the suicide rate was reduced to 1 postopera-tively compared with 15 in uncontrolled affectively disordered patients. Another retrospective study of 208 patients with depression anxiety and obsessional neuroses with a mean follow-up period of years demonstrated significant improvement in 68 of patients with depression 50 of patients with obsessional neurosis and of patients with other anxiety disorders 19 . Patients with other psychiatric disorders such as schizophrenia substance abuse or personality disorders responded poorly to the procedure. Adverse effects included short-term transient disinhibition syndromes headache confusion or somnolence personality changes were seen in of patients and seizures were seen in of patients. In this study there was one fatality resulting from migration of an Yttrium seed. Table 1 outlines early neurosurgical approaches for psychiatric indications. 346 Park et al. Fig. 6. Diagram of inferior aspect of orbitofrontal lobe. Area of restricted orbital undercutting as performed and described by Knight. Reprinted with permission from ref. 16. Fig. 7. T2 -weighted axial MRI of subcaudate tractotomy lesion in the subcaudate region bilaterally. Neurosurgical Treatments 347 Fig. 8. STT brachytherapy. Anteroposterior radiograph showing yttrium seeds used in Knight s original SST procedure. Reprinted with permission from ref. 60. One of the important technological advances that allowed for the development of more precise procedures was the .
