Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T05:01:07.492Z Has data issue: false hasContentIssue false

Stereotactic Limbic Leucotomy: Neurophysiological Aspects and Operative Technique

Published online by Cambridge University Press:  29 January 2018

Desmond Kelly
Affiliation:
Departments of Psychiatry and Neurosurgery of St. George's Hospital, Atkinson Morley's Hospital, 31 Copse Hill, London, S.W.20
Alan Richardson
Affiliation:
Departments of Psychiatry and Neurosurgery of St. George's Hospital, Atkinson Morley's Hospital, 31 Copse Hill, London, S.W.20
Nita Mitchell-Heggs
Affiliation:
Departments of Psychiatry and Neurosurgery of St. George's Hospital, Atkinson Morley's Hospital, 31 Copse Hill, London, S.W.20

Extract

Psychosurgery has always been, and is likely to remain, a controversial subject. Blind operations lack precision and can lead to adverse personality changes or other serious side-effects. Open surgery is becoming less acceptable because of the difficulties of accurately assessing the extent of a lesion and its exact location. The introduction of stereotactic techniques enables far smaller lesions to be placed with a high degree of accuracy, and increased knowledge of the limbic system has contributed to advances in this field.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1973

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.)

Footnotes

A synopsis of this paper was published in the December 1972 Journal.

References

Abrahams, V. C., Hilton, S. M., and Zbrozyna, A. (1960). ‘Active muscle vasodilatation produced by stimulation of the brain stem: its significance in the defence reaction.Journal of Physiology (London), 154, 491513.CrossRefGoogle ScholarPubMed
Balasubramaniam, V., and Ramamurthi, B. (1968). ‘Stereotaxic amygdalotomy.Proceedings of the Australian Association of Neurologists, 5, 277–8.Google ScholarPubMed
Ballantine, H. T., Cassidy, W. L., Flanagan, N. B., and Marino, R. (1967). ‘Stereotaxic anterior cingulotomy for neuropsychiatric illness and intractable pain.Journal of Neurosurgery, 26, 488–95.CrossRefGoogle ScholarPubMed
Barcroft, H., Brod, J., Hejl, Z., Hirsjarvi, E. A., and Kitchin, A. H. (1960). ‘The mechanism of the vasodilatation in the forearm muscle during stress (mental arithmetic).Clinical Science, 19, 577–86.Google ScholarPubMed
Clark, W. E. Le G. (1948). ‘The connexions of the frontal lobes of the brain.Lancet, i, 353–6.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.Journal of Neurology, Neurosurgery and Psychiatry, 13, 178–90.CrossRefGoogle ScholarPubMed
Heath, R. G., and Mickle, W. A. (1960). ‘Evaluation of seven years experience with depth electrode studies in human patients’, in Electrical Studies on the Unanesthetized Brain (ed. Ramey, and O'Doherty, ). New York.Google Scholar
Hilton, S. M., and Zbrozyna, A. W. (1963). ‘Amygdaloid region for defence reactions and its efferent pathway to the brain stem.Journal of Physiology (London), 165, 160–73.CrossRefGoogle Scholar
Hunter Brown, M., and Lighthill, J. A. (1968). ‘Selective anterior cingulotomy: a psychosurgical evaluation.Journal of Neurosurgery, 29, 513–19.Google Scholar
Jackson, H. (1954). ‘Leucotomy—a recent development.Journal of Mental Science, 100, 62–5.CrossRefGoogle Scholar
Kelly, D. H. W. (1966). ‘Measurement of anxiety by forearm blood flow.British Journal of Psychiatry, 112, 789–98.Google ScholarPubMed
Kelly, D. H. W. (1972). ‘Physiological changes during operations on the limbic system in man.Conditional Reflex. 7, 127–38.CrossRefGoogle ScholarPubMed
Kelly, D. H. W., Mitchell-Heggs, N., and Sherman, D. (1971). ‘Anxiety and the effects of sodium lactate assessed clinically and physiologically.British Journal of Psychiatry, 119, 129–41.CrossRefGoogle ScholarPubMed
Kelly, D. H. W., Richardson, A., Mitchell-Heggs, N., Greenup, J., Chen, C., and Hafner, R. J. (1973). ‘Stereotactic limbic leucotomy: a preliminary report on 40 patients.British Journal of Psychiatry, 122, 141–8.Google Scholar
Kelly, D. H. W., Walter, C. J. S., and Sargant, W. (1966). ‘Modified leucotomy assessed by forearm blood flow and other measurements.British Journal of Psychiatry, 112, 871–81.CrossRefGoogle ScholarPubMed
Kelly, D. H. W., Walter, C. J. S., Mitchell-Heggs, N., and Sargant, W. (1972). ‘Modified leucotomy assessed clinically, physiologically and psychologically at six weeks and eighteen months.British Journal of Psychiatry, 120, 1929.CrossRefGoogle ScholarPubMed
Knight, G. C. (1969). ‘Stereotactic surgery for the relief of suicidal and severe depression and intractable psychoneurosis.Postgraduate Medical Journal, 45, 113.CrossRefGoogle ScholarPubMed
Knight, G. C. and Tredgold, R. F. (1955). ‘Orbital leucotomy— a review of 52 cases.Lancet, i, 981–5.Google Scholar
Lewin, W. (1961). ‘Observations on selective leucotomy.Journal of Neurology, Neurosurgery and Psychiatry, 24, 3744.CrossRefGoogle ScholarPubMed
Livingston, K. E. (1953). ‘Cingulate cortex isolation for the treatment of psychoses and psychoneuroses.Research Publications of the Association for Research in Nervous and Mental Disease, 31, 374–8.Google ScholarPubMed
Livingston, K. E. (1969). ‘The frontal lobes revisited.Archives of Neurology, 20, 90–5.CrossRefGoogle ScholarPubMed
Livingston, R. B., Fulton, J. F., Delgado, J. M. R., Sachs, E., Brendeer, S. J., and Davis, G. D. (1948). ‘Stimulation and regional ablation of orbital surface of frontal lobe.Research Publications of the Association for Research in Nervous and Mental Disease, 27, 405–20.Google ScholarPubMed
MacLean, P. D. (1958). ‘Contrasting functions of limbic and neocortical systems of the brain and their relevance to psychophysiological aspects of medicine.American Journal of Medicine, 25, 611–26.CrossRefGoogle ScholarPubMed
MacLean, P. D. (1970). ‘The triune brain, emotion and scientific bias’, in The Neurosciences: Second Study Program (ed. F. O. Schmitt), pp. 336–49. New York.Google Scholar
MacLean, P. D. and Delgado, J. M. R. (1953). ‘Electrical and chemical stimulation of fronto-temporal portion of limbic system in the waking animal.Electroencephalography and Clinical Neurophysiology, 5, 91100.CrossRefGoogle Scholar
Magnus, O., and Lammers, H. J. (1956). ‘The amygdaloid-nuclear complex.Folia Psychiatrica, Neurologica Pet Neurochirurgica Neerlandica, 59, 555–82.Google ScholarPubMed
McKissock, W. (1959). ‘Discussion on psychosurgery.Proceedings of the Royal Society of Medicine, 52, 206–9.Google ScholarPubMed
Nauta, W. J. H. (1961). ‘Fibre degeneration following lesions of the amygdaloid complex in the monkey.Journal of Anatomy (London), 95, 515–31.Google ScholarPubMed
Nauta, W. J. H. (1971). ‘The problem of the frontal lobe: a reinterpretation.Journal of Psychiatric Research, 8, 167–87.CrossRefGoogle ScholarPubMed
Papez, J. W. (1937). ‘A proposed mechanism of emotion.Archives of Neurology and Psychiatry, 38, 725–43.CrossRefGoogle Scholar
Sano, K. (1966). ‘Sedative stereoencephalotomy-fornicotomy, upper mesencephalic reticulotomy and posteromedial hypothalamotomy’, in Progress in Brain Research (ed. Tokizane, T., and Schadé, J. P.). Amsterdam: Elsevier Publishing Co.Google Scholar
Smith, W. K. (1944). ‘The results of stimulation of the uncus and adjacent portion of the hippocampal gyrus.Federation Proceedings, 3, 43.Google Scholar
Smith, W. K. (1945). ‘Functional significance of the rostral cingular cortex as revealed by its responses to electrical excitation.Journal of Neurophysiology, 8, 241–55.CrossRefGoogle Scholar
Ström-Olsen, R., and Carlisle, S. (1971). ‘Bi-frontal stereotactic tractotomy. A follow-up study.British Journal of Psychiatry, 118, 141–54.CrossRefGoogle ScholarPubMed
Ward, A. A. (1948). ‘The cingular gyrus, area 24.Journal of Neurophysiology, 11, 1323.CrossRefGoogle ScholarPubMed
Yakovlev, P. I. (1965). Personal communication to Ballantine et al., 1967.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.