Transorbital Leukotomy for the Pain of Malignant Disease

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THE groundwork for all psychosurgery was laid by Egas Moniz.1 His original monograph, published in 1936, revealed that for some years he had been considering the possibility of interrupting projection fibers from the frontal lobes, as a therapeutic measure in certain psychoses. The first actual operations in this region were conceived and carried out by Moniz and Lima, and from their work have developed all the more recent and elaborate technics.

To Freeman and Watts,2 however, must go much of the credit for stimulating research along the lines of surgery on the frontal lobes, at least in the United States. The technic of prefrontal lobotomy described by them, together with their encouraging results, gave a tremendous impetus to the study of frontal lobe function from the surgical aspect, and brought psychosurgery to its present status.

Most of the early work was done, of necessity, in the treatment of mental disease, but it became evident to the observers who were following patients postoperatively, that there had been a definite change in the attitude of many patients with severe pain, as shown by the lessened emotional response to their suffering. Consequently, operations on the frontal lobes for the relief of intractable pain became common, and there is now a series of reports3–10 in the literature concerning the results of these procedures. The technics of operation have varied from the blind section originally described, through various stages to cortical ablation (gyrectomy or topectomy), including cortical undercutting11 and prefrontal lobotomy under direct vision.12,13. . .



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