Failed leucotomy with misplaced cuts: a clinico-anatomical study of two cases.

Abstract

Failure of treatment does not necessarily mean inappropriate treatment; it must first be ascertained that the treatment has been carried out. Increasing attention is being paid to this question in regard to drug therapy with estimations of blood and urine levels. Patients who fail to get better after leucotomy may have been unsuitably chosen; they may also fail to get better because the aim of the operation, namely to sever the thalamo-frontal radiations, has not been achieved. Neuro-anatomical studies have long suggested that not only do many patients remain with these tracts intact following a blind operative approach but that there is also great variability in the size and position of the lesions produced, a consequence of unreliable surface markings, brain fibre elasticity, complicating haemorrhages and progressive gliosis. The blind approach is no ideal surgical method, since it results in a largely fortuitous lesion (Meyer and McLardy, 1948, 1949; Beck, McLardy, and Meyer, 1950; Eie, 1954; Meyer and Beck, 1954). There is even a gross discrepancy between the actual and desired point of insertion of the leucotome (Dax, 1943). Whilst the effects of misplaced cuts have been studied by these workers, one can only guess what proportion of clinical failures can be attributed to misplaced cuts and what proportion of successes follow misplaced cuts (Meyer and Beck, 1954). Appeals for further studies with post-mortem correlates have been made by these authors.