9.23 Psychosurgery/Brain Surgery and Tumors

Physician's Notebooks 9 - http://physiciansnotebook.blogspot.com - See Homepage

23. Psycho-Surgery, Epilepsy Surgery, Parkinson's Surgery and Brain Tumor Management - Update 13 Septr 2021

Psychosurgery includes prefrontal lobotomy to modify the violent behavior of psychoses, and surgery of brain or spinal cord tracts to remove or modify pain or anxiety.  Also the partial removal of brain cortex or separation of right from left cortex may lower the frequency of severe epileptic fits and is now popular.

In Parkinson's Disease, brain surgery has had success in restoring normal movements and reducing tremor by stereotactic destruction of parts of the Basal Ganglia.

   Psychosurgery is controversial because of unwanted effects and because Brain is so important that the idea of removing or purposely damaging it seems wrong. The first psychosurgery came from descriptions of dramatic calming personality change produced in aggressive monkey by cutting across the prefrontal brain. This led to the prefrontal lobotomy knife slice across the front tip of brain in doctor office with special instrument inserted through upper part of eye socket. Portuguese neurosurgeon, Dr. Egas Moniz developed the procedure in 1936 and at its peak popularity in 1949, when he shared a Nobel Prize in medicine, 5,000 lobotomies were being done. The enthusiasm ended in 1950 with controversy whether it produced a zombie-like creature or a dramatic cure. Interest is reviving in a new technique, cingulotomy (cutting the cingulate projection fiber bundles). Each right and left cingulate bundle is on the inside of each cerebral hemisphere. It contains projection fibers running between neurons of the prefrontal area and the medial temporal memory center. The purpose of the cingulotomy is to disconnect part of frontal lobe from permanent memory stored in temporal lobe. Intellectual memory is not worsened; only emotional response goes missing. No brain is removed and side effects are said to be infrequent and the op is carried out with satisfactory success rate to help chronic cancer pain, severe depression and obsessive compulsive illness. (Note these are claims of the few neurosurgeons who do the procedures.)

   Psychosurgery is an option for very severe dysfunction, when other treatment has failed and remaining life expectancy is long enough to justify the radical attempt to improve it. Most psychosurgery is in the U.K. and Canada. A summary of 30 years, 1,300 operations is reported in journalist Nicci Gerrard’s London Observer article (also summarized in The Japan Times 11/14/1996 and available in library in The Japan Times building in Tokyo) with emphasis on stereotactic cingulotomy. Concerning feared side effects noted in the older lobotomy, the IQ in successful cases was claimed to rise postoperative because of release of motivation by success of controlling mental illness. Personal testimony by one survivor, a highly intelligent 68 y/o (in 1996, and I communicated with her in 2002) woman 16 years after her successful surgery for lifelong manic-depression suggests what it may be like to experience the surgery and how a mind recovers from manic-depressive illness after the surgery. Summary of psychosurgery can be found on Internet, typing in “Mind Info on Psychosurgery.”

Brain tumor (BT): Any growth inside the skull is catastrophic because it crushes normal brain. A benign BT like a meningioma is easily cured by surgery while a malignant tumor is not. In most BTs a craniotomy (opening of the skull) is done, first for tissue diagnosis and then for cure or palliation. Knowledge of the molecular signatures (chemical composition of the DNA from tumor) of certain tissue-diagnosed brain tumors (revealed by tests on the brain biopsy) has value because it tells which chemotherapy will be effective. Oligodendrogliomas that have combined deletions in chromosomes 1p and 19q respond well to certain chemotherapy and this increases survival by 10 years. 

With MRI brain scan that can pick up early brain tumor at 4 mm diameter (CT cannot; it starts at 10 mm) a pre-symptom screening diagnosis for BT is advisable because by the time the tumor causes symptoms it is larger than 10 mm and often incurable. We should get MRI of brain at risk point in life – after age 60. A good description what a malignant brain tumor can do is John Gunther's Death Be Not Proud. 

  Also to be mentioned are craniotomies and burr holes and shunts to relieve pressure from hemorrhage inside skull. These are often lifesaving.

  END OF CHAPTER. To read next click 9.24 Dementia/Secrets of Alzheimer's

        For fictional but accurate description of brain psychosurgery and tumor removal click 

• 13.9 Neurology Rounds, 13.10 Neurosurgery, 13.11 At the Operating Table, 13.12 Operating on the Living Brain
• 13.13 The Experiment

 For description of the radiation knife surgery of tumor, click and read the following chapters: from http:adventuresofkimi.blogspot.com  Slim Novel 12.

• 12.33 Dear Miss - Could You Help Me to Die?
• 12.34. Suicide Should be Painless
• 12.36 Helping Dan Die - The Morphine Effect

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