Hostname: page-component-669899f699-b58lm Total loading time: 0 Render date: 2025-04-26T07:28:46.984Z Has data issue: false hasContentIssue false
  • English
  • Français

Bi-frontal Stereotactic Tractotomy: An Atraumatic Operation of Value in the Treatment of Intractable Psychoneurosis

Part I. Anatomical and Surgical Observations

Published online by Cambridge University Press:  29 January 2018

Geoffrey C. Knight
Geoffrey C. Knight*
Affiliation:
Royal Postgraduate Medical School, London W.12; South East Metropolitan Regional Neurosurgical Centre, Brook Hospital
Get access Rights & Permissions [Opens in a new window]

Extract

Stereotactic surgery has provided a means of producing accurate lesions at selected points in the nervous system where concentrations of nerve cells or fibre pathways possessing specific functions permit some small area of anatomical destruction to produce widespread physiological effects. The value of this method in relation to motor and sensory activity is illustrated by the results of thalamotomy in the treatment of Parkinsonian tremor and by stereotactic division of the spinothalamic tract in the cervical cord for the relief of incurable pain. The accuracy of approach and minimal disturbance of tissue ensures that the beneficial effects of these operations are produced in isolation without associated disfunction in the nervous system. That a similar principle can be applied in relation to the control of emotion has been shown in cases of intractable psychoneurosis treated by the operation of bifrontal stereotactic tractotomy in the substantia innominata (Knight, 1964). Owing to the influence of emotion in psychoneurotic states it is possible to influence many syndromes satisfactorily by operation at a site where connections of the limbic system concerned with instinctive and emotional activity rather than cognitive processes converge to a point beneath the head of the caudate nucleus, thereby producing a reduction in the intensity of emotional reaction without undesirable personality change or post-operative epilepsy. It is felt that it would be useful to summarize the anatomical features in order that the differences between this operation and the old leucotomy procedure can be generally appreciated. It is particularly among cases of chronic and recurrent depression that this form of surgery can be most usefully employed.

Type
Psychosurgery
Information
The British Journal of Psychiatry , Volume 115 , Issue 520 , March 1969 , pp. 257 - 266
Copyright
Copyright © Royal College of Psychiatrists, 1969 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Andrew, J., and Nathan, P. W. (1964). “Lesions of the anterior frontal lobes and disturbances of micturition and defaecation.” Brain, 87, 233–262.CrossRefGoogle Scholar
Bailey, P., and Sweet, W. H. (1940). “Effects on respiration blood pressure and gastric motility of stimulation of orbital surface of frontal lobe.” J. Neurophysiol., 3, 276–281.CrossRefGoogle Scholar
Beck, E. (1949). “A cytoarchitectural investigation of cortical areas 13 and 14 in the human brain.” J. Anat. Lond., 83, 147–157.Google Scholar
Bucy, P. C. M. (1941). “Relationship of temporal lobes to primate behaviour.” Trans. Kansas City Ac. Med. (1939–1941), 223–233.Google Scholar
Clark, W. E. Le Gros (1948). “The connexions of the frontal lobe of the brain.” Lancet, 254, 353–356.Google Scholar
Clark, W. E. Le Gros and Meyer, M. (1950). “Anatomical relationships between the cerebral cortex and the hypothalamus.” Brit. med. Bull., 6, 341–345.Google Scholar
Cowan, W. M., and Powell, T. P. S. (1956). “A note on terminal degeneration in the hypothalamus.” J. Anat. Land., 90, 188–192.Google Scholar
Delgardo, J. M. R., and Livingston, R. B. (1948). “Some respiratory vascular and thermal responses to stimulation of orbital surface of frontal lobe.” J. Neurophysiol., 11, 39–55.Google Scholar
Economo, C. von (1929). The Cytoarchitectonics of the Human Cerebral Cortex. London: Oxford University Press.Google Scholar
Fulton, J. E. (1951). Frontal Lobotomy and Affective Behaviour: A Neurophysiological Analysis. New York: Morton.Google Scholar
Glees, P., Cole, J., Whitty, C. W. M., and Cairns, H. (1950). “The effects of lesions in the cingular gyrus and adjacent areas in monkeys.” J. Neurol. Neurosurg. Psychiat., 13, 178–190.Google Scholar
Herbert, E., and Jacobson, S. (1966). “Geriatric admissions to a mental hospital.” Brit. J. Psychiat., 112, 589–594.Google Scholar
Karda, B. R. (1951). “Somato-motor, autonomic and electrocorticographic responses to electrical stimulation of ‘skin encephalic’ and other structures in primate cat and dog.” Acta physiol. Scand., 24, suppl. 83, 38–168.Google Scholar
Kennard, M. A. (1944). In: The Precentral Motor Cortex, Bucy, P. C., ed. p. 295. Urbana, Ill.: University of Illinois Press.Google Scholar
Knight, G. C. (1943). “Observations on surgical technique.” J. Neurol. Neurosurg. and Psychiat., 89, 174–181.Google Scholar
Knight, G. C. (1960). “330 cases of restricted orbital cortex undercutting.” Proc. Roy. Soc. Med., 53, 728–732.Google Scholar
Knight, G. C. (1964). “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.” Brit. J. Surg., 51, 114–124.Google Scholar
Knight, G. C. (1965). “Stereotactic tractotomy in the surgical treatment of mental illness.” J. Neurol. Neurosurg. and Psychiatry, 28, 304.CrossRefGoogle Scholar
Knight, G. C. (1966). “Intractable psychoneurosis in the elderly and infirm.” Brit. Journal of Geriatric Practice (London), 3, No. 1, 7–15.Google Scholar
Knight, G. C. and Tredgold, R. (1955). “Orbital leucotomy—a review of 52 cases.” Lancet, i, 981–985.Google Scholar
Le Beau, J. (1952). “The cingular and precingular areas in psychosurgery (agitated behaviour, obsessive compulsive states, epilepsy).” Acta psychiat. et neurol. Scand., 27, 305–316.CrossRefGoogle Scholar
Le Beau, J. (1954). “Anterior cingulectomy in man.” J. Neurosurg., 11, 268–276.Google Scholar
Lewin, W. (1961). “Observations on selective leucotomy.” J. Neurol. Neurosurg. and Psychiat., 24, 37.Google Scholar
Livingston, R. B., Fulton, J. F., Delgardo, J. M. R., Sachs, E. Jr., Brendler, S. J., and Davis, G. D. (1948). “Stimulation and regional ablation of orbital surface of frontal lobe.” Res. Publ. Ass. new. ment. Dis., 27, 405–420.Google Scholar
Livingston, R. B., Chapman, W. P., Livingston, K. E., and Kraintz, L. (1948). “Stimulation of orbital surface of man prior to frontal lobotomy.” Ibid., 27, 421–432.Google Scholar
McLean, P. D. (1949). “Psychosomatic disease and the visceral brain.” Psychosom. Med., 11, 338–353.Google Scholar
Meyer, A., and Beck, E. J. (1945). “Neuropathological problems arising from prefrontal leucotomy.” J. ment. Sci., 91, 411–425.Google Scholar
Meyer, A. and McLardy, T. (1948). “Posterior cuts in prefrontal leucotomy.” Ibid., 94, 555–564.Google Scholar
Meyer, A., Beck, E., and McLardy, T. (1947). “Prefrontal leucotomy: a neuro-anatomical report.” Brain, 70, 18–49.Google Scholar
Meyer, Margaret (1949). “Study of efferent connexions of the frontal lobe in the human brain after leucotomy.” Ibid., 72, 244–296.Google Scholar
Miodonski, R. (1967). “Myeloarchitectonics and connections of substantia innominata in dog brain.” Acta Biol. Exper. (Warsaw), 27, 61–84.Google Scholar
Narabayashi, H., Nagao, T., Saito, Y., Hoshida, M., and Nagahata, M. (1963). “Stereotaxic amygdalotomy for behaviour disorders.” Arch. Neurol., 9, 1–16.Google Scholar
Nauta, W. J. H. (1961). “Fibre degeneration following lesions of the amygdaloid complex in the monkey.” J. Anat. (London), 95, 515–531.Google Scholar
Nauta, W. J. H. (1962). “The neural associations of the amygdaloid complex in the monkey.” Brain, 85, 505–520.Google Scholar
Papez, J. W. (1937). “A proposed mechanism of emotion.” Arch. Neurol. Psychiat. Chicago, 38, 725–743.Google Scholar
Powell, T. P. S., Cowan, W. M., and Raisman, G. (1963). “Olfactory relationships of the diencephalon.” Nature (London), 199, 710–712.Google Scholar
Rose, J. E., and Woolsey, C. N. (1948). “Structure and relations of limbic cortex and anterior thalamic nuclei in rabbit and cat.” J. comp. Neurol., 89, 279–340.Google Scholar
Smith, W. K. (1945). “The functional significance of the rostral cingular cortex as revealed by its responses to electrical excitation.” J. Neurophysiol, 8, 241–225.CrossRefGoogle Scholar
Spencer, W. G. (1894). “The effect produced upon respiration by faradic excitation of the cerebrum in the monkey, dog, cat and rabbit.” Philos. Trans., 195b, 609–657.Google Scholar
Ström-Olsen, R., and Tow, P. M. (1949). “Late social results of prefrontal leucotomy.” Lancet, i, 87–90.CrossRefGoogle Scholar
Sykes, M. K., and Tredgold, R. F. (1964). “Restricted orbital undercutting: a study of its effects on 350 patients over the ten years 1951–1960.” Brit. J. Psychiat., 110, 609–640.Google Scholar
Turner, E. (1963). “A new approach to unilateral and bilateral lobotomies for psychomotor epilepsy.” J. Neurol. Neurosurg. and Psychiatry., 26, 285–299.Google Scholar
Turner, E. (1967). “Posterior cingulectomy for personality disorder.” Paper delivered to S.B.N.S.—not yet published.Google Scholar
Walker, E. (1940). “Cytoarchitectural study of the pre-frontal area of the macaque monkey.” J. comp. Neurol., 73, 59–70.CrossRefGoogle Scholar
Ward, A. A. Jr. (1948a). “The cingular gyrus: area 24.” J. Neurophysiol., 11, 13–23.Google Scholar
Ward, A. A. Jr. (1948b). “The anterior cingular gyrus and personality.” Res. Publ. Ass. neru. ment. Dis., 27, 438–445.Google Scholar
Ward, A. A. Jr. and McCullough, W. (1947). “The projection of the frontal lobe on the hypothalamus.” J. Neurophysiol., 10, 309–314.Google Scholar
Wheatley, M. D. (1944). “The hypothalamus and affective behaviour in cats.” Arch. Neurol. Psychiat., 52, 296–316.Google Scholar
Whitty, D. M. (1955). “Effects of anterior cingulectomy in man.” Proc. Roy. Society of Medicine, 48, No. 6, 463–469. (Section of Psychiatry with Section of Neurology. Joint Meeting No. 3.) CrossRefGoogle Scholar
Yakovlev, P. I. (1948). “Motility, behaviour, and the brain.” J. new. ment. Dis. 107, 313–335.Google Scholar
Zeigler, L. H., and Osgood, C. W. (1945). “Edema and trophic disturbances of the lower extremities complicating prefrontal lobotomy.” Arch. Neurol. Psychiat. (Chicago), 53, 262–268.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.