Historical evolution of stereotactic amygdalotomy for the management of severe aggression

Restricted access

✓Friedrich Goltz first reported in the 1890s that temporal lobe removal had a taming effect in animals. The results of studies by Klüver and Bucy, and later Terzian and Ore, demonstrated that an amygdalectomy combined with a temporal lobectomy had a significant taming effect in both animals and humans. Based on these observations, Narabayashi and colleagues reported the first clinical series of patients with temporal lobe epilepsy and/or severe behavioral disturbances in which stereotactic amygdalotomy was performed to address aggressive disorders, using a frame-based stereo-tactic device designed by Narabayashi. Use of pneumoencephalography, combined with physiological localization by means of olfactory stimulation and field potential recordings, enabled these investigators to define the lateral part of the amygdala, while simultaneously using wax injections to create lesions. Chitanondh used a similar localization technique to produce medial amygdala lesions by injecting a mixture of olive oil, wax, and iodized oil.

In 1966, Heimburger and coworkers reported results from a series of 25 patients with epilepsy and aggressive behavior who underwent stereotactic amygdalotomy. Their technique was slightly different and their target localization was solely anatomical, based on pneumoencephalography or contrast ventriculography, and they utilized a cryoprobe to make lesions. In 1970, Balasubramaniam and Ramamurthi reported the largest clinical series to date on this technique; pneumoencephalography or contrast ventriculography was used for anatomical localization, and depth electrode recordings were used to obtain physiological confirmation of their targets, whereas either diathermy or a Bertrand loop was used for making lesions. The development of magnetic resonance imaging technology in late 1980 allowed for a more accurate anatomical localization of the amygdala, and the improvement of radiofrequency generators also made lesioning more precise. Despite these and subsequent technological advances, the number of amygdalotomies performed has geometrically decreased during the last 20 years.

Abbreviation used in this paper:EEG = electroencephalography.

Article Information

Address reprint requests to: Kostas N. Fountas, M.D., Ph.D., 840 Pine Street Suite 880, Macon, Georgia, 31201. email: knfountasmd@excite.com.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Balasubramaniam VRamamurthi B: Stereotaxic amygdalotomy. Proc Aust Assoc Neurol 5:2772781968

2

Balasubramaniam VRamamurthi B: Stereotaxic amygdalotomy in behavior disorders. Confin Neurol 32:3673731970

3

Balasubramaniam VRamamurthi BJagannathan KKalyanaraman S: Stereotaxic amygdalotomy. Neurol India 15:1191221967

4

Chitanondh H: Stereotaxic amygdalotomy in the treatment of olfactory seizures and psychiatric disorders with olfactory hallucination. Confin Neurol 27:1811961966

5

Fountas KNSmith JRLee GP: Bilateral stereotactic amygdalotomy for self-mutilation disorder. Case report and review of the literature. Stereotact Funct Neurosurg 85:1211282007

6

Goltz F: Der Hund ohne Grosshirn. Siebente Abhandlung über die Verrichtungen des Grosshirns. Arch f d ges Physiol 51:5706141892

7

Heimburger RFWhitlock CCKalsbeck JE: Stereotaxic amygdalotomy for epilepsy with aggressive behavior. JAMA 198:7417451966

8

Hitchcock ECairns V: Amygdalotomy. Postgrad Med J 49:8949041973

9

Hood TWSiegfried JWieser HG: The role of stereotactic amygdalotomy in the treatment of temporal lobe epilepsy associated with behavioral disorders. Appl Neurophysiol 46:19251983

10

Jacobson R: Disorders of facial recognition, social behavior and affect after combined bilateral amygdalotomy and subcaudate tractotomy—a clinical and experimental study. Psychol Med 16:4394501986

11

Klüver HBucy PC: An analysis of certain effects of bilateral temporal lobectomy in the Rhesus monkey, with special reference to psychic blindness. J Psychol 5:33341938

12

Klüver HBucy PC: Preliminary analysis of function of the temporal lobes in monkeys. Arch Neurol Psychiatr 42:97910001939

13

Klüver HBucy PC: Psychic blindness and other symptoms following bilateral temporal lobectomy in Rhesus monkeys. Amer J Physiol 119:3523531937

14

Klüver HBucy PC: “The temporal lobe syndrome” in temporal lobe epilepsy Springfield, IllCharles C. Thomas5045061958

15

Kopell BHRezai AR: Psychiatric neurosurgery: a historical perspective. Neurosurg Clin N Am 14:1811972003

16

Lee GPBechara AAdolphs RArena JMeador KJLoring DW: Clinical and physiological effects of stereotaxic bilateral amygdalotomy for intractable aggression. J Neuropsychiatry Clin Neurosci 10:4134201998

17

Narabayashi H: Lessons from amygdaloid surgery in long-term observation. Acta Neurochir Suppl Wien 232412451976

18

Narabayashi HNagao TSaito YYoshida MNagahata M: Stereotaxic amygdalotomy for behavior disorders. Arch Neurol 9:1161963

19

Ramamurthi B: Stereotactic operation in behavior disorders. Amygdalotomy and hypothalamotomy. Acta Neurochir Suppl Wien44:1521571988

20

Sano K: Sedative neurosurgery with special reference to posteromedial hypothalamotomy. Neurol Med Chir (Tokyo) 4:1121421962

21

Sano KSekino HMayanagi YResults of stimulation and destruction of the posterior hypothalamus in cases with violent, aggressive, or restless behaviors. Hitchcock ELaitinen LVaernet K: Psychosurgery Springfield, ILCharles C Thomas57751972

22

Small IFHeimburger RFSmall JGMilstein VMoore DF: Follow-up of stereotaxic amygdalotomy for seizure and behavior disorders. Biol Psychiatry 12:4014111977

23

Terzian HOre GD: Syndrome of Klüver and Bucy; reproduced in man by bilateral removal of the temporal lobes. Neurology 5:3733801955

24

van Manen Jvan Veelen CW: Experiences in psycho-surgery in The Netherlands. Acta Neurochir Suppl Wien44:1671691988

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 40 40 16
Full Text Views 112 112 6
PDF Downloads 56 56 6
EPUB Downloads 0 0 0

PubMed

Google Scholar