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LE BEAU J. The Surgical Uncertainties of Prefrontal Topectomy and Leucotomy (Observations on 100 Cases). ACTA ACUST UNITED AC 2018; 97:480-504. [PMID: 14861609 DOI: 10.1192/bjp.97.408.480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Three is no branch of neuro-surgery in which the assessment of results is more difficult than in psycho-surgery. The main sources of uncertainty are:(a)Mental impairment or improvement cannot yet be measured as precisely as neurological disorders, such as visual field or motor defects.(b)Spontaneous recovery and the influence of the incidental psychotherapy and drugs involved in any form of surgical attention cannot be evaluated with certainty in many cases.(c)Most of the cytoarchitectural fields of the frontal cortex cannot yet be defined during life by any physiological test or anatomical measurement.(d)Finally, from a technical point of view the surgeon is liable to produce many incidental lesions which cannot be ascertained during the patient's life.
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KNIGHT G. The orbital cortex as an objective in the surgical treatment of mental illness. The results of 450 cases of open operation and the development of the stereotactic approach. Br J Surg 2005; 51:114-24. [PMID: 14117767 DOI: 10.1002/bjs.1800510207] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Failure of treatment does not necessarily mean inappropriate treatment; it must first be ascertained that the treatment has been carried out. Increasing attention is being paid to this question in regard to drug therapy with estimations of blood and urine levels. Patients who fail to get better after leucotomy may have been unsuitably chosen; they may also fail to get better because the aim of the operation, namely to sever the thalamo-frontal radiations, has not been achieved. Neuro-anatomical studies have long suggested that not only do many patients remain with these tracts intact following a blind operative approach but that there is also great variability in the size and position of the lesions produced, a consequence of unreliable surface markings, brain fibre elasticity, complicating haemorrhages and progressive gliosis. The blind approach is no ideal surgical method, since it results in a largely fortuitous lesion (Meyer and McLardy, 1948, 1949; Beck, McLardy, and Meyer, 1950; Eie, 1954; Meyer and Beck, 1954). There is even a gross discrepancy between the actual and desired point of insertion of the leucotome (Dax, 1943). Whilst the effects of misplaced cuts have been studied by these workers, one can only guess what proportion of clinical failures can be attributed to misplaced cuts and what proportion of successes follow misplaced cuts (Meyer and Beck, 1954). Appeals for further studies with post-mortem correlates have been made by these authors.
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Toakley G. THE RELATIONSHIP OF THE ANTERIOR END OF THE VENTRICLES TO THE SKULL. Med J Aust 1955. [DOI: 10.5694/j.1326-5377.1955.tb37671.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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LE BEAU J. A comparison of the personality changes after prefrontal selective surgery for the relief of intractable pain and for the treatment of mental cases; cingulectomy and topectomy. THE JOURNAL OF MENTAL SCIENCE 1953; 99:53-61. [PMID: 13023367 DOI: 10.1192/bjp.99.414.53] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extensive lesions of the frontal lobes are followed by pronounced personality changes. This has been shown beyond doubt by the effect of neuro-surgery performed for the removal of brain tumours or for the relief of mental illness. To identify such changes and the lesions responsible for them at least four conditions seem necessary: (a) Knowledge of the limits, variations and connections of the main pre-frontal areas.—In this field the researches of Professor Alfred Meyer and his associates, Mrs. Beck and T. McLardy, are of primary importance (1950).
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