The first person to perform psychosurgery in China was the old president of our hospital, Prof. Su Zonghua. At that time, he performed 'frontal lobe leukotomy'. The first creator of this technique was Moniz, who cooperated with neurosurgeon Liman to treat patients with severe mental illness by surgically cutting off the white matter of the frontal lobe, which was quite successful. Later, American psychiatrist Freeman and neurosurgeon Watta*** designed the "standard prefrontal leukotomy", and from 1940 to 1955, the number of patients who underwent such surgery exceeded 1,000; according to Sargant's statistics, up to 1962, all types of psychosurgery in the United Kingdom amounted to 15,000 cases, and in the United States, the number of cases of psychosurgery was 15,000, and in the United States, the number of cases of psychosurgery reached 1,000. According to Sargant, by 1962, 15,000 psychosurgical procedures had been performed in the United Kingdom and 50,000 in the United States, for which Moniz was awarded the Nobel Prize in Medicine in 1949. However, it was later found that a considerable number of patients suffered some permanent sequelae after such surgeries, with a mortality rate and serious sequelae of at least 6%, and some cases of personality perversion or dementia after the surgery. The most famous case is that Rose Kennedy, the sister of former U.S. President John F. Kennedy, was subjected to this kind of surgery, which was called 'miracle' at that time, because of her repeated impulsive behavior, but as a result, she stayed in the psychiatric hospital for her whole life, and was unable to live a normal life at all. Many countries (such as the former Soviet Union and some states in the United States) have banned this procedure; although it is not explicitly banned in China, no one has engaged in this treatment or research since the 1950s.
Over the years, our hospital has 'deposited' a number of difficult-to-treat chronic schizophrenia cases, some of which had many serious impulsive assaults and injurious behaviors that were repeatedly treated, and finally had to be 'protected' day and night with leather handcuffs and imprisoned in a single patient room. In 1975, I read from foreign sources that neurosurgery had developed stereotactic surgical methods; foreign psychiatrists were also experimenting with such methods to treat intractable depression and obsessive-compulsive disorder. Some individual scholars reported that the refractory impulsive behavior of schizophrenic patients actually improved after stereotactic surgery. Thus, I sought advice from Prof. Jiang Da-jie, a pioneer in carrying out stereotactic surgery in neurosurgery in China at that time, and my senior brother, Prof. Jiang Da-suke, of the Department of Neurosurgery at Huashan Hospital, and learned that stereotactic surgery and frontal lobular leukotomy in those years were not the same thing. After reporting to Prof. Xia Zhenyi, the leaders of the two hospitals agreed to approve the first stereotactic surgery in cooperation with the Department of Neurosurgery of Huashan Hospital for the first time in the country for the first case of refractory schizophrenic patients with impulsive behavior as an official research topic. At that time, referring to the relevant foreign reports, the target points of destruction were bilateral cingulate gyrus, amygdala, subcaudate nucleus, and other 6 places; the result was relatively ideal, the leather handcuffs were lifted, and the case known as 'tiger' no longer hurt people impulsively for no reason. However, the mental symptoms were not relieved, and the hallucinatory delusions were not completely eliminated, even though antipsychotics were still used. Ten cases were operated on, all with similar efficacy, and the study achieved the predicted results, solving the problem of treating severe impulsive aggression and winning the Science and Technology Progress Award from the Shanghai Municipal Health Bureau.
The news spread, and then a flurry of psychiatry and neurosurgery departments in a number of hospitals across the country performed psychosurgery on a large number of schizophrenic patients. Some hospitals actually claim to have thousands of people waiting outside the hospital for surgery. I remember once working with Prof. Zhai Shutao at a hospital to appraise the results of their psychosurgical treatment. According to their report, as many as 85% of the psychiatric symptoms were relieved and disappeared after the surgery, but from the valid cases provided, it was hard to say that it was a standard schizophrenia. Professor Zhai Shutao and I exchanged views and reached a **** understanding of this: a collaborative group on psychosurgery should be set up by the National Psychiatric Association to standardize the research and treatment of psychosurgery; in Professor Zhai's words, "it can't be too hot, and some cold water should be poured on it".
The first national symposium on psychosurgery was held in Nanjing in November 1988, and a national collaborative group on psychosurgery was set up, headed by Zhai Shutao and Xu Jianping (an expert in stereotactic neurosurgery), and I was the deputy head of the group. Thanks to the formulation of some norms, and repeatedly reminded the brother units to strictly grasp the surgical indications, those enthusiastic doctors gradually realized that the surgical results were not as ideal as originally thought. This psychosurgical fever gradually cooled down after 1990. Of course, there are some more standardized studies, the results of which are mostly published in the "Journal of Functional and Stereotactic Neurosurgery".
Looking around the world, psychosurgeons abroad have concluded that the treatment of schizophrenia has been unsatisfactory, and so no one has ever looked at the treatment of schizophrenia. Reports over the years have suggested that the indications for psychosurgery are refractory depression and obsessive-compulsive disorder. Therefore, I cooperated with Director Liu Jiannong of the Department of Neurosurgery of Suzhou Guangji Hospital in the 1990s to try to treat refractory obsessive-compulsive disorder with stereotactic bilateral cingulate gyrus disruption. I remember that the effect of the first case is really encouraging, when the guide pin inserted into the cingulate bundle target position, turn on the radiofrequency heating, the patient reported that the obsessive-compulsive symptoms immediately disappeared. We were amazed that the patient's obsessive-compulsive thinking, which had caused him many years of pain, would be completely relieved after the surgery. For this reason, we also asked Prof. Xia Zhenyi to see the patient in Suzhou, Xia suggested that we should not be too excited, we should be cautious, and closely observe whether the efficacy is consolidated, there are no adverse reactions. We tried to treat 23 cases before and after, and 18 of them showed different degrees of improvement; however, all of them relapsed within 3 to 6 months, and had to be treated with drugs again. Fortunately, the adverse effects of bilateral cingulate gyrus disruption are rare, with only a few cases showing temporary impairment of consciousness and short-term urinary incontinence. I have also had many exchanges with American psychiatric surgeons, who share the same feeling that although the surgery is effective, the recurrence rate is very high, and in some cases, even two or three repeated surgeries have failed to solve the problem. Recently, I have seen reports of some organizations using the g-knife to treat refractory obsessive-compulsive disorder, and the efficacy of the treatment is said to be very satisfactory; however, when I privately asked the doctors who worked with them, they thought that the efficacy was not consolidated, and most of them relapsed.
As for the psychosurgical treatment of schizophrenia, exactly how much efficacy, so far there is no very reliable, scientific follow-up and analysis. In the Internet, I read that the director of a hospital in Northeast China believes that the so-called schizophrenia patients cured after surgery reports are all fiction. Anyway, in the outpatient clinic, we can often see some cases with surgical scars on the head, while still taking a lot of antipsychotics, mental symptoms have not been relieved.
Recently, I saw some propaganda materials on the Internet, and now some of the academic content of an excerpt from the following: " Commonly used surgical methods are: cingulate gyrus destruction, destruction of the anterior limb of the internal capsule, the caudate nucleus under the conduction bundle cut off, the hypothalamus posterior medial destruction of the operation, and so on. Different surgical methods are suitable for different psychiatric disorders: ① cingulate gyrus disruption is suitable for affective psychiatric disorders; ② endocapsular anterior limb disruption is effective for obsessive-compulsive disorder, anxiety disorders, social phobia, and depression; ③ caudate subnucleus conduction tract amputation is effective for chronic and recurrent depressive disorders, and has been reported to be effective in treating obsessive-compulsive disorders; ④ posterior medial hypothalamus disruption is mainly used in the treatment of aggressive and destructive behaviors, and sympathetic nervousness and irritability symptoms. The posterior medial hypothalamic disruption is mainly used for the treatment of aggressive and destructive behavior and sympathetic nervousness and agitation. Among them, the significant improvement rate of internal capsule forelimb destruction in the treatment of obsessive-compulsive disorder was more than 82%, the quality of life was significantly improved, and 93% of the patients were no longer taking medication. It also has good effect on anxiety and depression, especially panic, depression, suicidal tendency, hypochondriacal and somatic symptoms, etc. The improvement rate is more than 60%. Some of the symptoms of chronic schizophrenia are also significantly improved, mainly emotional reaction and behavioral disorders, self-talk, laughing for no reason, etc. After the operation, the patients' medication is significantly reduced and easy to manage. ...... ①The biggest surgical risk of cingulate gyrus disruption is epilepsy. Short-term side effects include mild confusion, emotional impairment, and near-memory impairment, and patients usually recover within a few weeks after surgery. The short-term side effects include mild confusion, emotional impairment, and near-memory disturbances, and patients usually recover within a few days. The common side effects include short-term fatigue, mental confusion, and near-memory impairment, which usually recover within a few days. A few patients may suffer from more serious complications such as lack of motivation, poor initiative, and personality disorders. (iii) The main side effects of subcaudate nucleus conduction tract amputation are postoperative confusion, mild word and visual memory loss, which usually recover in a few weeks to a few months. ④ Posterior medial hypothalamic disfigurement surgery side effects are mild, some patients have mild drowsiness, especially the internal capsule anterior limb disfigurement produced by delayed personality changes, lack of interest, behavioral disorders, etc., although the incidence rate of less than 5%, but it is still unclear why it occurs and how to prevent it."
Generally speaking, this publicity material is more truthful, but it seems to have been exaggerated for the efficacy of the foreign recognized recent efficacy of no more than 30%, up to 68%; for the risk of surgery has also been narrowed down, foreign reports of epilepsy after the surgery rate of at least 2.2%, personality disorders may be as much as 6.7% or more. These surgeries are the product of 30 years ago, in the 1970s, and are all about destruction of brain tissue. There is no reliable basis for the claim in the publicity materials that "different surgical procedures are appropriate for different psychiatric disorders", and the reason why these targets were chosen at that time was simply based on the results of some animal studies. For example, we chose to destroy the amygdala in cases of impulsive aggression based on experiments in which cats were no longer irritable after the destruction of the amygdala. After the surgery, the patients were milder and no longer aggressive, which was actually a personality change due to the disfiguring surgery. Unfortunately, however, there has been little further research or improvement in these areas for thirty years.
Foreign neurosurgery and psychosurgery have recognized the serious flaws of disfiguring surgery and have shifted their research interests to topics that are not brain tissue disfiguring. For example, deep brain stimulation DBS, has moved from the treatment of Parkinson's disease, to try to cure refractory depression; but they are still limited to research, rather than as a formal treatment of depression or obsessive-compulsive disorder, and besides, this treatment can be withdrawn at any time, to return to its original state. Recently, I read from the famous scientific journal Nature (July issue) that some scientists placed electrodes in the motor area of the brain of a paraplegic patient, recorded the brain waves of single or multiple brain cells, and interpreted them, which resulted in the patient being able to move the mouse pointer on the computer screen with his mind, and manipulate the opening or closing of certain instruments or amenities (see accompanying figure). This is truly positive psychosurgery and research. It is hoped that doctors interested in psychosurgery can broaden their horizons and turn their energies to psychosurgical research with more positive significance. At the same time, we also call on the relevant health authorities to pay attention to this corner of psychosurgery, and to develop codes of practice in this area, to provide positive guidance and prevent negative trends.
We should realize that psychosurgery is, after all, only a topic worthy of study, and not a formal treatment that can be engaged in a large number of