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Gracias a los avances técnicos en técnicas neuroquirúrgicas, y debido a que el diagnóstico y la clasificación de las enfermedades psiquiátricas han evolucionado significativamente a lo largo de las últimas décadas, se están desarrollando tratamientos a nivel experimental para aquellos pacientes resistentes al manejo conservador.La anorexia nerviosa es una enfermedad de prevalencia creciente, con la tasa de mortalidad más elevada dentro de los trastornos psiquiátricos, y con aproximadamente un 20% de pacientes que presentan una evolución tórpida. Para estos pacientes que no responden a manejo conservador, la estimulación cerebral profunda ha surgido como una alternativa terapéutica, si bien la literatura especializada al respecto es escasa.A continuación presentamos una revisión de la fisiopatología de la anorexia nerviosa, así como de los distintos tratamientos neuroquirúrgicos realizados a lo largo de la historia. Se detalla la perspectiva de tratamiento quirúrgico actual, así como los aspectos éticos que se han de considerar en relación con el surgimiento de estas nuevas terapias. [ABSTRACT FROM AUTHOR]

Objective: on neurosurgery functional an important issue has been on selection of the steroetactic target for stimulation or ablations' injuries in many neurological problems. Our purpose of this paper is to analysis our experience with the conventional target and reviews our experience with the functional targets in neurosurgery department. Material and methods: we analyzed functional targets and some modifications that we made in one each by functional neurosurgical section into Neurosurgery department at Centro Medico Nacional "20 de Noviembre" ISSSTE Mexico City. Parkinson's disease and severe dystonias were the diagnosis in 45 patients, in 26 patients with psychiatrist diseases as obsessive compulsive disorders (OCD), severe aggressive disorder, anorexia and bulimia. Results: we made modifications on the time of termocoagulation from 60 to 90 seconds in some cases developed a local edema during the first 24 hs especially when the target was striatum which disappear spontaneously. Amygdale injury was decided through direct visualization method, (to search the amygdale on its impression in the temporal horn). That target has marked in cortical medial group of the nuclear complex amygdaloidal. In dystonia patients it was observed better clinical improvement using as reference the Laitinen target besides and the target modification through of the globes pallidus direct visualization method on T2 weight by RM test. Conclusions: we have observed an important variety of the functional targets in the word medical literature. We decided to share to you a modified table of the functional targets that we had success tested. We hope that could be a useful guide as another reference. Moreover we are sharing our experience with modifications targets for synchronize of the same circuits involved on the central nervous system. [ABSTRACT FROM AUTHOR]

Purpose: the psychosurgery or neurosurgery for psychiatric disorders has had a long and controversial history, until the present with contributions from different doctors as the Swiss psychiatrist Gottlieb Burckhart, doctors Egas Moniz. There have been enthusiastic collaborators as well as detractors. The evolution of anesthetic and surgical techniques has given to neurological surgery for psychiatric disorders to be a possible alternative treatment. The most important advances in esterotaxic techniques have been proved to be a safe procedure and with favorable results. Methods: we present three cases of patients with eating disorders; they were presented to a committee of psychosurgery to be evaluated. Zamboni's thalatomy (with bilateral involvement of the lamella medialis) and the limbic leucotomies Kelly's modified. The latter consisting in a combined method in which injuries are performed stereotacticly approximately 6 mm in diameter through cryogenics or thermocoagulation specific targets in 2 points: anterior capsule and cingulum, seeking to disrupt this tract talamocortical (corticostriatalthalamic tract), fibers passing through the arm above the internal capsule (frontal radiation trough thalamus) and connecting with the orbitofrontal cortex and the limbic system bidirectional connections between the frontal lobes (prefrontal areas, limbic circuit) and the prefrontal corticopontine tract. Results: in 12 to 36 months for assessment, we found significant improvement in symptoms related to depression, and disability in the scale of Sheehan, improvement in aggressiveness. Do not have significative (p value) improvement in obsessive-compulsive disorder by the scale of Yale / Brown, anxiety and impulsivity, but they have to statistical tendence to clinical improvement. Conclusions: we have found the association of eating disorders and obsessive-compulsive disorder to improve symptoms OCD patients with eating disorders who have not responded to treatment. This may be an alternative safe and effective. [ABSTRACT FROM AUTHOR]

Psychosurgery is, in neurosurgery, a relatively new form of facing psychiatric illness. From the long ago abandoned techniques of Moniz to the modern era or deep brain stimulation, not only technology has evolved, but also has done so the philosophical concepts behind surgery for psychiatric illness. Deep brain simulation avoids the risks of ablative procedures while gradually surgery for mental diseases with cognitive components has been abandoned in favor of affective or motor disorders. Nevertheless several issues remain unanswered. Where does the person sit: in his/her brain or in his/her whole body? What does define the person, its rational and mental behavior or his dual nature of body and spirit? When brain death supervenes, the person is really dead? All of these issues in the middle of a positivist and materialist way of thinking have reduced the concept of human being to brain function. Psychosurgery, with its risk of changing personality and behavior, challenges the concept of brain-mind dilemma and makes us rethink if, as Descartes said five centuries ago, the soul sits in the pineal gland. [ABSTRACT FROM AUTHOR]

Recent background in neurosurgery for psychiatric disorders can be placed in the mid XIXth century. Buckhartd made partial resection of frontal cortex in 6 psychiatric patients, with successful results in 4 of them, but important side effects prevented the development of this scientific approach. In 1936 Egas Moniz and Almeida Lima performed a new neuro-psychiatric technique for treatment of several psychiatric disorders, named prefrontal lobotomy. Results of this treatment won Moniz a Nobel Prize in 1949, and encouraged Freeman and Watts to further develop this kind of surgery in United States of America. [ABSTRACT FROM AUTHOR]