{"id":"c1e09e0b-8318-4119-a411-7c951b5c528b","slug":"bilateral-hypothalamotomy-plus-dominant-amygdalotomy-with-gamma-knife-radiosurgery-a-non-invasive-alternative-when-everything-has-failed-in-the-management-of-aggressive-behavior-disorder","title":"Bilateral hypothalamotomy plus dominant amygdalotomy with Gamma Knife radiosurgery. A non-invasive alternative when everything has failed in the management of aggressive behavior disorder","authors":["Oscar I. Molina Romero","Juan Carlos Diez-Palma","Andrés Fonnegra-Caballero","Andrés Segura-Hernández","Roberto Matinez-Alvarez","Edgar Yamhure","Julian Felipe Camargo","Julio Roberto Fonnegra-Pardo"],"abstract":"Background: Impulsive aggression is the core symptom of intermittent explosive disorder, which can be a feature of several psychiatric disorders. There is a subset of individuals who do not respond adequately to medical treatment; they are treatment refractory. The objective of this report is to describe a case of a patient with a background of schizophrenia and concomitant refractory aggressiveness disorder, treated with two-stage bilateral hypothalamotomy and unilateral amygdalotomy with Gamma Knife radiosurgery (GKR). Case Description: A 36-year-old male presented with a background of paranoid schizophrenia. Episodes of self- and hetero-aggressiveness were present at the initial diagnosis. High dosages of psychotropic medication were taken, and 70 sessions of electroconvulsive therapy were performed; however, no adequate response was obtained. Bilateral hypothalamotomy plus left amygdalotomy through GKR was performed. After 25 months of follow-up, a marked decrease in the frequency, degree, severity of aggressiveness and the requirement for psychotropic medications was observed. Conclusion: Hypothalamotomy plus amygdalotomy with Gamma Knife may be an effective ablative technique for the management of refractory aggressive disorder in patients with mental illness.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/c1e09e0b-8318-4119-a411-7c951b5c528b/featured/hero-1781558987144.png","publishDate":"2024-12-20T00:00:00.000Z","doi":"10.25259/SNI_860_2024","categories":["Neuropsychiatry","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2024/12/13296/SNI-15-469.pdf"}