Early history[ edit ] Trepanningthe practice of drilling holes in the skull, was performed from prehistoric times to the early Middle Ages and then again during the Renaissance. The operation was a topectomy, in which parts of the frontal, parietal and temporal cortex were excised. Other psychiatrists were not enthusiastic about his work and he abandoned his operations. Moniz, working with neurosurgeon Pedro Almeida Lima, started operating on patients in late
Psychosurgery Definition Psychosurgery is the treatment of a psychiatric disorder using surgical techniques to destroy brain tissue and is now rarely used.
Purpose It is a last-resort treatment for extreme, debilitating, psychiatric disorders. Description Early psychosurgery—historical perspective Ironically, brain surgery, a medical practice requiring extraordinary levels of skill and care, may be one of the oldest of all medical procedures.
This surprising observation is supported by physical evidence dating back 40, years ago to Neolithic times. Archeologists have found numerous human skulls showing signs of a procedure called trepanation or trepanning—an operation in which a hole is cut through the bone that covers the brain skull in order to access the brain.
A key feature of the wounds found in these ancient skulls is the smoothness and shininess around the edges of the holes. This is a clear sign of new bone growth and evidence that the person whose skull was opened not only survived the operation but lived months or even years afterwards while the bone regrew.
Having one's skull opened in a modern surgical setting is not taken lightly, even with the most modern surgical techniques.
The prospect of undergoing the operation in the late Stone Age may appear to us to imply certain death. However, the survival rate of the operation was quite high. That number is actually higher than the survival rate for brain surgery during the nineteenth century, when Stone Age trepanned skulls were first identified.
Trepanned skulls have been found all over the world, including sites in PeruChinaIndiaand Franceand parts of the Middle East and Africa.
While trepanning is an effective surgical technique for relieving pressure on the brain caused by bleeding, most archeologists suspect the operation was carried out in the Stone Age to achieve a different goal.
Trepanning, they suspect, was performed to release evil spirits or demons, which the shamans or witch doctors of the time believed produced symptoms of what we know as mental disorders and, perhaps, diseases of the brain.
The instruments used in trepanning were likely to have been made of obsidian, a very hard, glasslike, volcanic rock that can hold a very sharp cutting edge. There is also evidence that the end of a wooden stick, hardened by fire and turned back-and-forth rapidly while pressed against the skull may have served as a primitive, but effective, surgical drill.
Neuroscientist and author Elliot Valenstein believes that trepanning did not amount to intentional brain surgery. He quotes from the Latin text by the twelfth-century surgeon Roger of Salerno, who wrote: Some unscrupulous individuals wandered across Europe convincing gullible people that mental disorders were caused by a "stone of madness.
The impetus for developing a radical treatment Unfortunately, effective treatments for mental illnesses remained unavailable until the second half of the twentieth century.
During the eighteenth century, more humane conditions of confinement were introduced, but effective treatments remained unavailable. Physicians were desperate for treatments that might make it easier to control violent and deranged patients. By the end of the nineteenth century, researchers became aware of the role played by the frontal cortex—a part of the brain located behind the forehead—in behavior control.
They discovered from the results of animal experiments and observing humans who suffered damage to this part of the brain that the frontal lobes affect emotions and behavior.
This bit of knowledge, combined with the development of effective anesthesia, led to the first modern instances of psychosurgery during the s. A Swiss surgeon named Gottlieb Burkhardt deliberately damaged the frontal lobes of six psychiatric patients in hopes of relieving psychiatric symptoms; at least one of his subjects died and the experimental surgery was discontinued amid criticism from other physicians.
Inan Estonian surgeon, Lodivicus Pussepp, picked up where Burkhardt left off. He cut nerve tracks leading from the frontal lobes to other parts of the brain in psychiatric patients, with unimpressive results.
A decade later, he injected tissue-destroying chemicals into the frontal lobes of mentally ill patients through holes drilled over the frontal lobes. Although the procedure accomplished little or nothing in the way of therapy, Pussepp remained optimistic about the ability of this procedure to improve the condition of psychiatric patients.
Interest in the frontal lobes as a target for treating mental disorders continued on a small scale until the heyday of psychosurgery began in the s.
Inresearchers in the United States reported that damaging the frontal lobes and a nearby region of the brain called the prefrontal cortex could pacify a previously aggressive chimpanzee.
A Portuguese psychiatristAntonio Egas Moniz, learned of these results and recruited neurosurgeon Almeida Lima to operate on some humans suffering from severe psychoses.
Moniz's aim was to disconnect nerve pathways running from the frontal lobes to a part of the brain called the thalamus, which is located closer to the center of the brain.
By cutting these connections, Moniz hypothesized that he could disconnect a neural circuit that ran from the frontal cortex to the thalamus and then to other parts of the brain's surface. He hoped that interrupting this pathway would disrupt the repetitive thoughts that Moniz believed were responsible for psychotic symptoms.He identified a number of problems with the newer forms of psychosurgery: the lack of any reliable theoretical position relating to psychosurgery, with different forms of surgery used in similar cases, and similar surgery used for a wide range of psychiatric conditions; the absence of controlled trials; the difficulty in assessing changes in character caused by the surgery; and the irreversible nature of .
Psychosurgery History and Early Prefrontal Lobotomy Burkhardt reported the first use of psychosurgery modern times in (Cosgrove, Rauch, ). The most well-known example of dramatic psychosurgery is that of a prefrontal lobotomy.
Despite its wretched history, psychosurgery is back with a new name—neurosurgery for mental disorders—and with renewed confidence in its benefits.1 Two technologies are now available that produce small lesions in the brain: stereotactic microablation and gamma knife radiation (no .
Apr 15, · Long-term sequelae were known as the “frontal lobe syndrome”, and included inertia, apathy, social withdrawal, and attention deficit,31 Bleeding is also another complication of this method, occasionally being fatal Postoperative complications, including mortality, reduced considerably after the introduction of stereotactic surgery Here we report the main complications that persist with the .
Psychosurgery is a general label for any surgery that is performed on the brain to alleviate mental illness. Psychosurgery generally involves destruction of specific areas of the brain. The frontal lobe, located at the front of the brain, is the largest of the four major lobes of the cerebral cortex in mammals.
The frontal lobe is located at the front of each cerebral hemisphere (in front of the parietal lobe and the temporal lobe).