sábado, 13 de abril de 2013

A brief history of psychosurgery

To all doctors, we need a little history of medicine. We must learn the past to change the future.
In April 05, 2013, the periodic Surgical Neurology International published a very interesting article about the history of psychosurgery. The author describes the trepanations done in Peru by the Incas to cure mental illness and the respective tools used. He talks about the case of Gage, the man who acquired mental impairment after penetrating brain injury to the frontal lobe. The case become famous and is called "American Crowbar Case". From being a motivated, energetic, capable, friendly, and conscientious worker, Gage changed dramatically into an obstinate, irreverent, irresponsible, socially uninhibited individual. These changes in personality would later be recognized as the frontal lobe syndrome. The author talks about "the lobotomist", Dr. Walter Freeman (1895-1972), who has made transorbital leucotomy by using a modified ice-pick instrument to traverse the roof of the orbit and enter the base of the skull with local anesthesia. Freeman hoped that physicians would use this simple technique to treat hospitalized patients widely.  Many physicians became disappointed with the results, as some patients developed complications or died. But the majority of patients were improved, severe symptoms ameliorated, most families were gratified, and institutionalized patients became more manageable in the various institutions.
Recently, the BBC News showed mentally ill patients held in chains in Indonesia as the picture below. The question is, how should we treat these patients so humanized? Their families need help too. Click in the link to read this news.

Mentally ill patients held in chains
Psychosurgery was developed early in human prehistory (trephination) as a need perhaps to alter aberrant behavior and treat mental illness. The "American Crowbar Case" provided an impetus to study the brain and human behavior. The frontal lobe syndrome was avidly studied. Frontal lobotomy was developed in the 1930s for the treatment of mental illness and to solve the pressing problem of overcrowding in mental institutions in an era when no other forms of effective treatment were available. Lobotomy popularized by Dr. Walter Freeman reached a zenith in the 1940s, only to come into disrepute in the late 1950s. Other forms of therapy were needed and psychosurgery evolved into stereotactic functional neurosurgery. A history of these developments up to the 21st century will be related in this three-part essay-editorial, exclusively researched and written for the readers of Surgical Neurology International (SNI).
Keywords: Frontal lobes, institutionalization, lobotomy, mentally ill, psychosurgery, trephination
Author: Miguel A Faria
Clinical Professor of Neurosurgery (ret.) and Adjunct Professor of Medical History (ret.), Mercer University School of Medicine; President, www.haciendapub.com, Macon, Georgia, USA
The Extraction of The Stone of Madness (or The Cure of Folly) by Hieronymus Bosch. Museo del Prado, Madrid, Spain

Dr. Walter Freeman and the frontal transorbital lobotomy

How to cite this article:
Faria MA. Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy. Surg Neurol Int 2013;4:49

How to cite this URL:
Faria MA. Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy. Surg Neurol Int [serial online] 2013 [cited 2013 Apr 13];4:49. Available from: http://www.surgicalneurologyint.com/text.asp?2013/4/1/49/110146

Dr. Bernardo de Andrada

segunda-feira, 1 de abril de 2013

Incidence of Neurosurgical Wrong-Site Surgery

Artigo publicado na revista Neurosurgery de Abril de 2013 por Jay Vaccani sobre a incidência de neurocirurgias realizadas do lado errado. A incidência de craniotomias do lado errado chega de 2 a 3 por 10.000 nos Estados Unidos.
BACKGROUND: Although exceedingly rare, wrong-site surgery (WSS) remains a persistent problem in the United States. The incidence is thought to be 2 to 3 per 10 000 craniotomies and about 6 to 14 per 10 000 spine surgeries. In July 2004, the Joint Commission mandated the Universal Protocol (UP) for all accredited hospitals.
OBJECTIVE: To assess the effect of UP implementation on the incidence of neurosurgical WSS at the University of Illinois College of Medicine at Peoria/Illinois Neurological Institute.
METHODS: The Morbidity and Mortality Database in the Department of Neurosurgery was reviewed to identify all recorded cases of WSS since 1999. This was compared with the total operative load (excluding endovascular procedures) of all attending neurosurgeons to determine the incidence of overall WSS. A comparison was then made between the incidences before and after UP implementation.
RESULTS: Fifteen WSS events were found with an overall incidence of 0.07% and Poisson 95% confidence interval of 8.4 to 25. All but one of these were wrong-level spine surgeries (14/15). There was only 1 recorded case of wrong-side surgery and this occurred after implementation of the UP. A statistically greater number of WSS events occurred before (n = 12) in comparison with after (n = 3) UP implementation (P < .001).
CONCLUSION: A statistically significant reduction in overall WSS was seen after implementation of the UP. This reduction can be attributed to less frequent wrong-level spine surgery. There was no case of wrong procedure or patient surgery and the 1 case of wrong-side surgery occurred after UP implementation.
ABBREVIATIONS: JC, Joint Commission
UP, Universal Protocol
WSS, wrong-site surgery
Author Information
Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine in Peoria, Peoria, Illinois
Correspondence: Jay A. Vachhani, MD, Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine in Peoria, 530 NE Glen Oak Ave, Peoria, IL 61637. E-mail: jay.vachhani@gmail.com
Received May 24, 2012
Accepted December 04, 2012

Full article: