Invented by Canadian neurosurgeon Dr. Kenneth G. McKenzie in the 1940s, the leucotome has a narrow shaft which is inserted into the brain through a hole in the skull, and then a plunger on the back of the leucotome is depressed to extend a wire loop or metal strip into the brain. The leucotome is then rotated, cutting a core of brain tissue.[1] This type was used by the Nobel Prize-winning Portuguese neurologist Egas Moniz.[2]
Another, different, surgical instrument also called a leucotome was introduced by Walter Freeman for use in the transorbital lobotomy. Modeled after an ice-pick, it consisted simply of a pointed shaft. It was passed through the tear duct under the eyelid and against the top of the eyesocket. A mallet was used to drive the instrument through the thin layer of bone and into the brain along the plane of the bridge of the nose, to a depth of 5cm. Due to incidents of breakage, a stronger but essentially identical instrument called an orbitoclast was later used.[4]
Lobotomies were commonly performed from the 1930s to the 1960s, with a few as late as the 1980s in France.[5]
Neuroscience is the scientific study of the nervous system, its functions, and its disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, developmental biology, cytology, psychology, physics, computer science, chemistry, medicine, statistics, and mathematical modeling to understand the fundamental and emergent properties of neurons, glia and neural circuits. The understanding of the biological basis of learning, memory, behavior, perception, and consciousness has been described by Eric Kandel as the "epic challenge" of the biological sciences.
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nervous system, and cerebrovascular system. Neurosurgery as a medical specialty also includes non-surgical management of some neurological conditions.
Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorders. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt. The first significant foray into psychosurgery in the 20th century was conducted by the Portuguese neurologist Egas Moniz who, during the mid-1930s, developed the operation known as leucotomy. The practice was enthusiastically taken up in the United States by the neuropsychiatrist Walter Freeman and the neurosurgeon James W. Watts who devised what became the standard prefrontal procedure and named their operative technique lobotomy, although the operation was called leucotomy in the United Kingdom. In spite of the award of the Nobel prize to Moniz in 1949, the use of psychosurgery declined during the 1950s. By the 1970s the standard Freeman-Watts type of operation was very rare, but other forms of psychosurgery, although used on a much smaller scale, survived. Some countries have abandoned psychosurgery altogether; in others, for example the US and the UK, it is only used in a few centres on small numbers of people with depression or obsessive-compulsive disorder (OCD). In some countries it is also used in the treatment of schizophrenia and other disorders.
A lobotomy or leucotomy is a discredited form of neurosurgical treatment for psychiatric disorder or neurological disorder that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, to be severed.
Trepanning, also known as trepanation, trephination, trephining or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull. The intentional perforation of the cranium exposes the dura mater to treat health problems related to intracranial diseases or release pressured blood buildup from an injury. It may also refer to any "burr" hole created through other body surfaces, including nail beds. A trephine is an instrument used for cutting out a round piece of skull bone to relieve pressure beneath a surface.
Harvey Williams Cushing was an American neurosurgeon, pathologist, writer, and draftsman. A pioneer of brain surgery, he was the first exclusive neurosurgeon and the first person to describe Cushing's disease. He wrote a biography of physician William Osler in three volumes.
In medicine, a catheter is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Catheters are manufactured for specific applications, such as cardiovascular, urological, gastrointestinal, neurovascular and ophthalmic procedures. The process of inserting a catheter is called catheterization.
António Caetano de Abreu Freire Egas Moniz, known as Egas Moniz, was a Portuguese neurologist and the developer of cerebral angiography. He is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure leucotomy—better known today as lobotomy—for which he became the first Portuguese national to receive a Nobel Prize in 1949.
Joseph Edward Murray was an American plastic surgeon who is known as the "father of transplantation" for major milestones in the field of transplantation, including performing the first successful human kidney transplant, defining brain death, the organization of the first international conference on human kidney transplants and founding of the National Kidney Registry, the forerunner of the current United Network Of Organ Sharing (UNOS). By 2013, more than one million patients are estimated to have benefitted from organ transplantation around the world.
Walter Jackson Freeman II was an American physician who specialized in lobotomy. Wanting to simplify lobotomies so that it could be carried out by psychiatrists in psychiatric hospitals, where there were often no operating rooms, surgeons, or anesthesia and limited budgets, Freeman invented a transorbital lobotomy procedure. The transorbital approach involved placing an orbitoclast under the eyelid and against the top of the eye socket; a mallet was then used to drive the orbitoclast through the thin layer of bone and into the brain. Freeman's transorbital lobotomy method did not require a neurosurgeon and could be performed outside of an operating room, often by untrained psychiatrists without the use of anesthesia by using electroconvulsive therapy to induce seizure and unconsciousness. In 1947, Freeman's partner James W. Watts ended their partnership because Watts was disgusted by Freeman's modification of the lobotomy from a surgical operation into a simple "office" procedure.
The study of neurology and neurosurgery dates back to prehistoric times, but the academic disciplines did not begin until the 16th century. The formal organization of the medical specialties of neurology and neurosurgery are relatively recent, taking place in Europe and the United States only in the 20th century with the establishment of professional societies distinct from internal medicine, psychiatry and general surgery. From an observational science they developed a systematic way of approaching the nervous system and possible interventions in neurological disease.
The Johns Hopkins University School of Medicine (JHUSOM) is the medical school of Johns Hopkins University, a private research university in Baltimore, Maryland. Founded in 1893, the School of Medicine shares a campus with Johns Hopkins Hospital and Johns Hopkins Children's Center, established in 1889.
An orbitoclast was a surgical instrument used for performing transorbital lobotomies.
From the ancient Egyptian mummifications to 18th-century scientific research on "globules" and neurons, there is evidence of neuroscience practice throughout the early periods of history. The early civilizations lacked adequate means to obtain knowledge about the human brain. Their assumptions about the inner workings of the mind, therefore, were not accurate. Early views on the function of the brain regarded it to be a form of "cranial stuffing" of sorts. In ancient Egypt, from the late Middle Kingdom onwards, in preparation for mummification, the brain was regularly removed, for it was the heart that was assumed to be the seat of intelligence. According to Herodotus, during the first step of mummification: "The most perfect practice is to extract as much of the brain as possible with an iron hook, and what the hook cannot reach is mixed with drugs." Over the next five thousand years, this view came to be reversed; the brain is now known to be the seat of intelligence, although colloquial variations of the former remain as in "memorizing something by heart".
Atkinson Morley Hospital (AMH) was located at Copse Hill near Wimbledon, south-west London, England from 1869 until 2003. Initially a convalescent hospital, it became one of the most advanced brain surgery centres in the world, and was involved in the development of the CT scanner. Following its closure, neuroscience services were relocated to the new Atkinson Morley Wing of St George's Hospital, Tooting.
James Winston Watts was an American neurosurgeon, born in Lynchburg, Virginia. He was a graduate of the Virginia Military Institute as well as the University of Virginia School of Medicine. Watts is noteworthy for his professional partnership with the neurologist and psychiatrist Walter Freeman. The two became advocates and prolific practitioners of psychosurgery, specifically the lobotomy. Watts and Freeman wrote two books on lobotomies: Psychosurgery, Intelligence, Emotion and Social Behavior Following Prefrontal Lobotomy for Medical Disorders in 1942, and Psychosurgery in the Treatment of Mental Disorders and Intractable Pain in 1950.
Adamo Mario "Amarro" Fiamberti was an Italian psychiatrist who was the first to perform a transorbital lobotomy in 1937. The technique was widely applied by Fiamberti in Italy and by Walter Freeman in the United States, with different tools. Fiamberti was later named Director of the Psychiatric Hospital of Varese, when it was opened in 1964.
Howard Dully is an American memoirist who is one of the youngest survivors of the transorbital lobotomy, a procedure performed on him when he was 12 years old.
Psychosurgery is a surgical operation that destroys brain tissue in order to alleviate the symptoms of mental disorder. The lesions are usually, but not always, made in the frontal lobes. Tissue may be destroyed by cutting, burning, freezing, electric current or radiation. The first systematic attempt at psychosurgery is commonly attributed to the Swiss psychiatrist Gottlieb Burckhardt who operated on six patients in 1888. In 1889 Thomas Claye Shaw reported mental improvement in a case of General Paralysis of the Insane after a neurosurgical intervention. This led to a lively debate in the British Medical Journal on the usefulness of neurosurgery for the treatment of insanity. In the 1930s the Portuguese neurologist Egas Moniz developed a surgical technique for the treatment of mental illness and called it "leucotomy" or "psychosurgery". Moniz' technique was adapted and promoted by American neurologist Walter Freeman and his neurosurgeon colleague James W. Watts. They called their operation, where burr holes are drilled in the side of the skull and the white matter is sliced through in order to sever the connections between the frontal lobes and deeper structures in the brain, lobotomy. In the United Kingdom it became known as the standard Freeman-Watts prefrontal leucotomy. British psychiatrist William Sargant met Freeman on a visit to the United States and on his return to England encouraged doctors at the Burden Neurological Institute in Bristol. The surgeon who performed Leucotomy operations there was Dr Harold Crow who treated my father after an unknown surgeon in London performed the operation on him without his consent, which had an awful effect on his personality and empathy after he was invalidated on returning to UK after working as an intelligence officer in Lille spying on German collaborators but was poisoned in his drink by a German officer with subsequent anxiety for his digestion and for our family. Despite this he worked all through his life to finance our education - programme of psychosurgery.
Psychosurgery, also called neurosurgery for mental disorder or functional neurosurgery, is surgery in which brain tissue is destroyed with the aim of alleviating the symptoms of mental disorder. It was first used in modern times by Gottlieb Burckhardt in 1891, but only in a few isolated instances, not becoming more widely used until the 1930s following the work of Portuguese neurologist António Egas Moniz. The 1940s was the decade when psychosurgery was most popular, largely due to the efforts of American neurologist Walter Freeman; its use has been declining since then. Freeman's particular form of psychosurgery, the lobotomy, was last used in the 1970s, but other forms of psychosurgery, such as the cingulotomy and capsulotomy have survived.
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