bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2024-727bekhterev-925Research ArticleПРОБЛЕМНЫЕ СТАТЬИPROBLEM-S0LVING ARTICLESВозможности нейрохирургии для коррекции симптомов психических и поведенческих расстройствNeurosurgery as an opportunity to correct symptoms of mental and behavioural disordershttps://orcid.org/0000-0003-4136-628XКрыловВ. В.KrylovV. V.

Крылов Владимир Викторович, академик РАН, доктор медицинских наук, профессор, главный внештатный специалист нейрохирург Минздрава РФ, главный научный сотрудник отделения неотложной нейрохирургии; зав. кафедрой Фундаментальной нейрохирургии

129090, г. Москва, Б. Сухаревская пл., д. 3

117997, г. Москва, ул. Островитянова д. 1

Vladimir V. Krylov

Moscow

krylov@neurosklif.ruhttps://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.

Рак Вячеслав Августович, кандидат медицинских наук, врач-нейрохирург; ассистент кафедры Фундаментальной нейрохирургии ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России

129090, г. Москва, Б. Сухаревская пл., д. 3

117997, г. Москва, ул. Островитянова д. 1

Viacheslav A. Rak

Moscow

rak@neurosklif.ruНИИ скорой помощи им. Н.В. Склифосовского ДЗМ ; РНИМУ им. Н.И. ПироговаРоссияSklifosovsky Research Institute of Emergency Care; The Russian National Research Medical University named after N.I. PirogovRussian FederationНИИ скорой помощи им. Н.В. Склифосовского ДЗМРоссияSklifosovsky Research Institute of Emergency CareRussian Federation2024080220245811629Copyright © Крылов В.В., Рак В.А., 20232023Крылов В.В., Рак В.А.Krylov V.V., Rak V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/925

История нейрохирургического подхода к лечению пациентов с психическими расстройствами во многом противоречива. Эта часть нейрохирургии, впоследствии названная изобретателем префронтальной лейкотомии и лауреатом Нобелевской премии Egaz Moniz «психохирургией», в период своего становления развивалась не на основе научных изысканий, а благодаря энтузиазму отдельных специалистов и по причине острой социальной необходимости. Несмотря на то, что некоторые операции демонстрировали хорошие результаты, уровень методологии клинических исследований в то время не позволил непредвзято оценить эффекты вмешательств. Исходом психохирургии стало негативное отношение к ней как широкой общественности, так и врачебного сообщества, значительное сокращение исследований в данной области, а также запрет на проведение таких операций во многих странах мира – наступила «эра психофармакологии». Однако, несмотря на впечатляющие результаты лекарственной терапии, у части пациентов, особенно с тяжелым течением психического расстройства, не удается добиться ремиссии консервативными методами.

За последние несколько десятилетий появились новые методы нейровизуализации, значительное развитие получила нейробиология, что позволило расширить знания о физиологии мозга человека. Совокупность полученной информации существенно улучшила понимание патогенеза психических расстройств, благодаря чему удалось обрести научную обоснованность хирургического вмешательства в области конкретных структур головного мозга. В настоящей работе кратко описаны основные этапы развития психохирургии, изложены некоторые клинические и хирургические аспекты проводимых в настоящее время нейрохирургических операций для коррекции симптомов психических расстройств, в том числе локализация мишеней для воздействия, исходы и осложнения нейрохирургического лечения. Освещено применение новых методов в нейрохирургии, таких как стимуляция глубинных структур и стереотаксическая радиохирургия на аппарате гамма-нож. Часть работы посвящена этическим, правовым и терминологическим вопросам.

Neurosurgical treatment for psychiatric disorders has a controversial history. This branch of neurosurgery called by developer of prefrontal leucotomy and Nobel prize laureate Egaz Moniz “psychosurgery”, was initially based not on scientific researches, but on enthusiasm of individuals and pressing social need. The outcome of psychosurgery regardless of its clinical benefits was the negative attitude of the broad masses and medical community, some countries have banned psychosurgery – the era of psychopharmacology has come. However, some patients suffering from severe course of the psychiatric disorder are resistant to conservative treatment.

Over the last decades, the novel neuroimaging methods and neurobiological researches have considerably improved understanding of the pathogenesis of psychiatric disorders and scientific validity of the surgical intervention into the neural circuits. In this article, the main stages of the history of the psychiatric neurosurgery are briefly reviewed. Furthermore, the clinical and surgical considerations including the anatomic target localization, outcome and possible complications of the major operations which are still in practice are presented. The new neurosurgical techniques such as deep brain stimulation and gamma knife stereotactic radiosurgery were also considered. The part of the article is devoted to ethical, legal and terminological issues of psychiatric neurosurgery.

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The authors declare that there are no conflicts of interest present.