Prefrontal Cortex Lesions from Neurosurgeon and Patient Perspective

Prefrontal Cortex Lesions from Neurosurgeon and Patient Perspective

In this paper, I will discuss lesions of the

prefrontal cortex from the perspective of the practice of

neurosurgery (in particular, the sub-field of psychosurgery) and

then I will consider some studies that look at the implications

of lesions to the prefrontal cortex to the brain and behavior,

from the perspective of the patient with the lesion. Initially,

I will start with the history and explanation of psychosurgery.

Psychosurgery is the branch of neurosurgery that involves

severing or otherwise disabling areas of the brain to treat a

personality disorder, behavior disorder, or other mental illness

(Rodgers 1992). Modern psychosurgical techniques target the

pathways between the limbic system (the portion of the brain on

the inner edge of the cerebral cortex) that is believed to

regulate emotions, and the frontal cortex, where thought

processes are seated.

The field of neurosurgery as a specialty was not defined

until the end of the 19th century. In earlier days, surgeries

had to be tailored to poor lighting and lack of magnification

(Valenstein 1986). The development and implementation of the

operating microscope in the 1960s allowed surgeons to operate

through a narrow tunnel to resect deep-seated lesions

(Valenstein 1986). Psychosurgery, and lobotomy in particular,

reached the height of use just after World War II. Between 1946

and 1949, the use of the lobotomy grew from 500 to 5,000 annual

procedures in the United States (Valenstein 1986). Lobotomy is a

psychosurgical procedure involving selective destruction of

connective nerve fibers or tissue. It is performed on the

frontal lobe of the brain and its purpose is to alleviate mental

illness and chronic pain symptoms (Valenstein 1986). At that

time, the procedure was viewed as a possible solution to the

overcrowded and understaffed conditions in state-run mental

hospitals and asylums. Known as prefrontal or transorbital

lobotomy, depending on the surgical technique used and area of

the brain targeted, these early operations were performed with

surgical knives, electrodes, suction, or ice picks, to cut or

sweep out portions of the frontal lobe.

Today's psychosurgical techniques are much more refined.

These technological advances include the use of computer-

assisted stereotaxis, intra-operative ultrasound, brain mapping

and endoscopy. Minimally invasive surgery is a major advance in

neurosurgery and refers not only to a more limited skin incision