Tratamiento neuroquirúrgico de la agresividad irreductible: Hipotalamotomía posteromedial estereotáxica

Pablo Hernández; Mario Orrego; Humberto Prinzo; Fernando Martínez; Cristina Medina; Esteban Pollo

Authors

Pablo Hernández Hospital Regional de Tacuarembó, Equipo de Estereotaxia y Neurocirugía Funcional, Coordinador. Neurocirujano
Mario Orrego Universidad de la República, Facultad de Medicina, Clínica Psiquiátrica, Profesor Director. Hospital Vilardebó, Equipo de Rehabilitación Taller de Autogestión y Percepción, Coordinador
Humberto Prinzo Hospital Regional de Tacuarembó, Equipo de Estereotaxia y Neurocirugía Funcional, Neurocirujano
Fernando Martínez Hospital Regional de Tacuarembó, Equipo de Estereotaxia y Neurocirugía Funcional, Residente de Neurocirugía
Cristina Medina Hospital Vilardebó, Equipo de Rehabilitación Taller de Autogestión y Percepción, Prof. de Filosofía
Esteban Pollo Hospital Regional de Tacuarembó, Anestesista

Keywords:

AGGRESSION, PERSONALITY DISORDERS, HIPOTALAMUS, STEREOTAXIC TECHNIQUES, PSYCHOSURGERY

Abstract

Background: a 30 years old man, carrier of an organic disorder of the personality who presented frequent episodes of pathologic predator subtype aggressive behavior.
Out of control episodes were sporadic during childhood; from 15 years syndrome was worsening even under treatment, unforeseeable became more frequent and violent.
Successive and combined pharmacological treatments were used (neuroleptics, antipsychotics, benzodiacepines, anticonvulsants and beta blockers), electroconvulse therapy and multiple rehabilitation therapies. Neurosurgery was chosen as conventional therapy had failed.
Procedures: posteromedial hypothalamotomy was performed by stereotactic radiofrequency procedure under general anesthesia, and computed tomography localization. No post-operatory complications were found.
Results: during the following weeks after surgery, the patient remained calm and the pharmacological program was changed: the vast doses of psychodrugs (haloperidol, olanzapine, lorazepam) and beta blockers (propranolol) were ceased, but anticonvulsant (valproate) was maintained. He immediately restarted the group therapy without incidents and social activities with his family. During the differed evolution, the patient gradually recovered personal features and abilities prior to the beginning of refractory process. After nine months of follow up, his clinical condition regarding pathologic aggressive behaviour subtype predatory as well as personal and familial quality of life had improved.

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