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Psychosurgery Revisited: Frontal Lobotomy Lesions Estimated with Diffusion Tensor Imaging

Glenn Fox and Robert F. Dougherty
Department of Psychology, Stanford University

Frontal lobotomy psychosurgery came into widespread use in the 1940's. Nearly 50,000 patients underwent some form of lobotomy in an effort to remedy various pathologies, such as: schizophrenia, severe depression and OCD. The procedure took two forms: the Freeman-Watts procedure, and the Transorbital method. In the Freeman-Watts procedure, a neurosurgeon cuts White Matter (WM) pathways by entering the brain at several points along the coronal suture. Freeman later developed the transorbital lobotomy, an outpatient procedure that attempted to sever similar WM pathways by entering the brain through the eye socket. While these procedures occasionally achieved a modest reduction in symptoms, progress often came at the cost of severe cognitive and social impairments. Here we calculate the effect of this procedure by simulating frontal lobotomy psychosurgery using Diffusion Tensor Imaging and fiber tracking to estimate affected WM pathways. Both procedures effectively severed the anterior thalamic peduncle, the inferior longitudinal fasciculus, frontal-callosal connections, the uncinate fasciculus and the cingulum. Our retrospective analysis has shown that the procedure effectively severed the frontal-thalamic connections that the surgeons explicitly targeted (the anterior thalamic peduncle), but also severed several other major pathways, thus resulting in pervasive psychological effects. These methods may be applicable towards a better understanding of modern psychosurgical techniques (e.g.; cingulotomy) in use today for the treatment of refractory psychiatric conditions.

Supported by NIH EY015000

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