Prefrontal Cortex Lesions from Neurosurgeon and Patient Perspective :: Surgery Surgical Health Essays

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