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Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.
Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorder. 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 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.
Bilateral cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today, it is mainly used in the treatment of depression and obsessive-compulsive disorder. In the early years of the twenty-first century, it was used in Russia to treat addiction. It is also used in the treatment of chronic pain. The objective of this procedure is the severing of the supracallosal fibres of the cingulum bundle, which pass through the anterior cingulate gyrus.
The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, according to Alfred Nobel's 1895 will, are awarded "to those who, during the preceding year, have conferred the greatest benefit to humankind". Nobel Prizes are awarded in the fields of Physics, Chemistry, Physiology or Medicine, Literature, and Peace.
The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere. It is parted from the parietal lobe by a groove between tissues called the central sulcus and from the temporal lobe by a deeper groove called the lateral sulcus. The most anterior rounded part of the frontal lobe is known as the frontal pole, one of the three poles of the cerebrum.
Walter Rudolf Hess was a Swiss physiologist who won the Nobel Prize in Physiology or Medicine in 1949 for mapping the areas of the brain involved in the control of internal organs. He shared the prize with Egas Moniz.
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.
Walter Jackson Freeman II was an American physician who specialized in lobotomy.
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.
A leucotome or McKenzie leucotome is a surgical instrument used for performing leucotomies and other forms of psychosurgery.
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 the first to perform a transorbital lobotomy in 1937. 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. Dully received international attention in 2005, following the broadcasting of his story on National Public Radio. Subsequently, in 2007, he published a New York Times Best Seller memoir, My Lobotomy, a story of the hardships of his lobotomy, co-authored by Charles Fleming.
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 to instigate a programme of psychosurgery.
Johann Gottlieb Burckhardt was a Swiss psychiatrist and the medical director of a small mental hospital in the Swiss canton of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical operation. Born in Basel, Switzerland, he trained as doctor at the Universities of Basel, Göttingen and Berlin, receiving his medical doctorate in 1860. In the same year he took up a teaching post in the University of Basel and established a private practice in his hometown. He married in 1863 but the following year he was diagnosed with tuberculosis and gave up his practice and relocated to a region south of the Pyrenees in search of a cure. By 1866 he had made a full recovery and returned to Basel with the intention of devoting himself to the study of nervous diseases and their treatment. In 1875, he attained a post at the Waldau University Psychiatric Clinic in Bern, and from 1876 he lectured on mental diseases at the University of Bern. Beginning in this period, he published widely on his psychiatric and neurological research findings in the medical press, developing the thesis that mental illnesses had their origins in specific regions of the brain.
Sir Wylie McKissock, OBE was a British neurosurgeon. He set up the neurosurgical unit at the Atkinson Morley Hospital, was Britain's most prolific leucotomist (lobotomist), and president of the Society of British Neurological Surgeons.
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.
John Farquhar Fulton was an American neurophysiologist and historian of science. He received numerous degrees from Oxford University and Harvard University. He taught at Magdalen College School of Medicine at Oxford and later became the youngest Sterling Professor of Physiology at Yale University. His main contributions were in primate neurophysiology and history of science.
References
- ↑ Acharya, Hernish J. (2004). The Rise and Fall of Frontal Leucotomy. Archived 2018-02-19 at the Wayback Machine In Whitelaw, W.A. The Proceedings of the 13th Annual History of Medicine Days. Calgary: p. 40.
- ↑ "The Nobel Prize in Physiology or Medicine 1949 Walter Hess, Egas Moniz". Nobelprize.org. Retrieved 6 July 2010.
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