An Evaluation of Bimedial Leucotomy

Abstract

An attempt is reported here to evaluate the results of a modified form of leucotomy. Subjects of the investigation were 64 consecutively operated patients, for all of whom the same technique of bimedial leucotomy was employed. This operation is similar to the full division of white matter (as described by Poppen, 1948) through a superior frontal approach, but the cut is limited to the medial 2 cm. (Greenblatt and Solomon, 1952). The operation is carried out under direct vision through two 4 cm. trephine openings placed immediately anterior to the coronal suture on either side of the midline. The plane of the cut is found with a brain needle and extends from the middle of the trephine opening (2 cm. in front of the coronal suture) to the line of the sphenoidal ridge. The white matter is cut with a metal sucker for a width of about 2 cm. subjacent to grey matter medially and inferiorly. The incision skirts the front of the lateral ventricles and divides the thalamo-frontal bundle, thereby isolating the cortex of the frontal pole and also interfering with the fibres to the remaining anterior prefrontal areas which lie in the midcentral segment of white matter. This cut does not necessarily extend sufficiently far back to interfere with all the fibres related to area 13, but is free from the disadvantages of misplacement into the septal area.