A study of pneumoencephalograms before and after prefrontal lobotomy (Freeman-Watts technic).

Abstract

Prefrontal leukotomy as defined by Egas Moniz (1) consists in the destruction of “the more or less fixed arrangements of cellular connections which exist in the brain and particularly those which are related to the frontal lobes.” This was first accomplished by the injection of alcohol into the subcortical prefrontal white matter. Later severance of these fibers was achieved by means of a hollow needle or “leukotome,” or by a blunt dissector, as in Freeman and Watts technic (2). In the latter method the dissector was moved in the arc of a circle in a perfectly vertical plane anterior to the tip of the frontal horns of the ventricles immediately beneath the coronal sutures. Bleeding apparently was usually minimal. Method of Study From May 21, 1947, to July 15, 1948, prefrontal leukotomies were done in 32 psychotic patients. In all but one of these pneumoencephalography was done prior to the operative procedure. The operations were performed by Dr. Robert Watson.3 We were able to obtain preoperative pneumoencephalograms for 19 of the 32 patients. This was an unselected random sample dictated by feasibility alone. It is our purpose in the present study to describe the pneumoencephalographic picture in these 19 unselected cases before prefrontal lobotomy and for variable periods of time up to twenty months following the surgical procedure, and to correlate our findings with autopsy observations made here and elsewhere. Preoperative pneumoencephalography was usually performed several days preoperatively or at least within a period of eight weeks. In 5 cases, however, the interval prior to operation was three to nine months. The postoperative studies were done anywhere from four months to twenty months following prefrontal leukotomy, usually after one year or more. The patients were all white males with the exception of one Negro male. Their ages ranged from 24 to 66 years, 7 being over 38 years of age. The duration of the psychosis exceeded three years except in one instance, in a 54-year-old white male who had a known psychosis for only nine months. Although 11 of the patients received some form of shock therapy, in no instance was there any form of therapeutic procedure between the time of preoperative pneumoencephalography and the prefrontal leukotomy. Pneumoencephalographic Findings Prior to Prefrontal Leukotomy In 9 of the patients, the pneumoencephalographic findings prior to prefrontal leukotomy could be considered as normal or at the upper limits of normal. In 6 of this group the pneumoencephalograms were normal in every respect; in 3 the ventricular measurements were at the upper limits of normal.