Возможности нейрохирургии для коррекции симптомов психических и поведенческих расстройств

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.

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