prefrontal leucotomy
Prefrontal leucotomy, also known as prefrontal lobotomy, is an obsolete treatment for schizophrenia, whereby the white matter tracts of the frontal lobes were interrupted surgically via bilateral frontal burr-holes.
Radiographic features
CT and MRI
The prefrontal lobotomy has symmetrical white matter cavitary lesions in the anterior portion of the frontal lobes. MR imaging is more effective than CT in the diagnosis of prefrontal lobotomy and its secondary degenerations.
The loss of injured tissue secondary to a prefrontal lobotomy results in bilateral cavitary lesions with fanlike shapes that are surrounded by dense gliosis, which is best seen as hyperintense unenhanced surrounding area on FLAIR. CT scans reveal that these lesions are CSF attenuation cavities.
History and etymology
Prefrontal leucotomy was developed in 1935 by Egas Moniz, a Portuguese neurologist.
This psychosurgery produced a good therapeutic response and, in 1949, Moniz won the Nobel Prize in Medicine or Physiology for his discovery. Popularity of prefrontal lobotomy decreased during the 1960s after the development of effective psychopharmacologic agents, including chlorpromazine, for the treatment of mental diseases.
Differential diagnosis
- sequelae of old contusions: both cerebral cortex and white matter are damaged in these cases; in the case of prefrontal lobotomy, lesions do not involve the cortex except for the needle entry site
- bilateral border zone (watershed) infarctions between the anterior and middle cerebral arteries: border zone infarctions usually have their maximum diameters in the anteroposterior directions, and central cavities are rarely seen
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