Ablative stereotactic neurosurgery for irreducible neuroaggressive disorder in pediatric patients
| Autor: | Manuel Hernández Salazar, Antonio Zarate Méndez, Oscar Meneses Luna, Lucía Ledesma Torres, Ramón Paniagua Sierra, Mary Carmen Sánchez Moreno, Juan Leonardo Serrato Avila |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Psychotropic Drugs Adolescent Hypothalamus Posterior Neuroimaging Child Behavior Disorders Amygdala Gyrus Cinguli Magnetic Resonance Imaging Psychosurgery Aggression Stereotaxic Techniques 03 medical and health sciences 0302 clinical medicine Treatment Outcome Surgery Computer-Assisted Internal Capsule 030220 oncology & carcinogenesis Intellectual Disability Humans Female Child Dandy-Walker Syndrome 030217 neurology & neurosurgery |
| Zdroj: | Neurocirugia (English Edition). 29(6) |
| ISSN: | 2529-8496 |
| Popis: | The irreducible neuroaggressive disorder (IND) is a well-described entity known to be associated with impulsive and aggressive behavior. While various studies have assessed available pharmacological and non-pharmacological treatment regimens, patients with IND continue to pose a major threat to themselves and society. While targeted stereotactic therapy for IND has gained traction in recent years, there is a paucity of information describing comparative effectiveness of different validated anatomic regions. In this paper, we discuss the surgical results for patients with IND following targeted lesional therapy with a special focus on selection criteria and operative methods. The objective is to analyze the efficacy and safety of the different described targets for this disorder in pediatric patients.Eight pediatric patients met strict criteria for IND and were enrolled in this study. Electroencephalography (EEG), video electroencephalography (VEEG) and magnetic resonance imaging (MRI) were performed in all patients prior to surgery. Irreducible neuroagressive symptom was approached by lesional therapy based on most described targets for this disorder and assessed by The Overt Agressive Scale (OAS) pre-operatively and 6 months following surgery, using Wilcoxon test for statistical analysis.The average patient age was 13 years 2 months. 7 of the 8 patients enrolled had intellectual disabilities, 1 patient suffered neurologic sequelae referable to Dandy Walker syndrome and 7 patients had no preoperative anatomical alterations. Following surgery, patients with IND noted improvement in their OAS. On average, the OAS improved by 39.29% (P=.0156), a figure similar in comparison to studies assessing treatment of IND in adult patients. The most satisfactory results were achieved in patients whose ablative therapy involved the Amygdala in their targets. There were no deaths or permanent neurological deficits attributable to procedure. To the author's knowledge, this is the largest series described in the literature for pediatric patients with IND treated with lesional stereotactic therapy. |
| Databáze: | OpenAIRE |
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