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Methods of Marking the Plane of Section in the Open Lobotomy Operation

1950; Radiological Society of North America; Volume: 54; Issue: 5 Linguagem: Inglês

10.1148/54.5.741

1527-1315

Benjamin B. Whitcomb, William Beecher Scoville,

Neurological disorders and treatments

A number of methods have been devised for visualizing the plane of section following lobotomy. Lipiodol was used successfully for this purpose by Freeman and Watts (1), but in the "open" lobotomy the lipiodol may fall to the basal cisterns or enter the lateral ventricles and be distributed throughout the spinal fluid pathways of the brain and spinal cord. A gross method used by the authors and others has been the application of silver clips at the base, mid-portion, and apex of the vertical plane of section in the open operation. An angled clip applicator is useful for insertion of these clips at the base of the plane of section. Putnam (2) first suggested the use of tantalum wire markers in various types of lobotomy. For the standard open lobotomy operation and for cortical under cutting of selected areas of the prefrontal cortex (as performed by Scoville), the authors have used 30-gauge stainless steel wire loops as markers, bending the tips of the loops backward upon themselves in order to blunt them (Fig. 1). This procedure has been employed in 43 cases over a period of nine months, with 3 instances of non-recurrent convulsions. A new method of marking the plane of section, to be presented here, makes use of tantalum powder,2 which has also been used by Hamby (3) for marking the site of operation for protruded lumbar disks.3 This extremely fine powder is purchased in 1-gm. amounts, in the form of a heavy black dust, and may be placed in a standard powder atomizer and insufflated into the plane of section at the end of the lobotomy procedure. It adheres to the margins of the section and does not appear to enter either ventricle or basal cisterns. Postoperative anteroposterior and lateral films (Fig. 2) reveal both the vertical and lateral extent of the plane of section. This method has been used in over 125 cases without visible harmful effects or any increase in the incidence of epilepsy.