A new look at bimedial prefrontal leukotomy

Forty-four selected patients with "hard core" functional psychiatric illness were treated by bimedial prefrontal leukotomy, in which only the medial half of the prefrontal white matter of both frontal lobes was divided. This operation differs from the conventional or "standard" leukotomy which divides the entire prefrontal white matter. There were six patients with personality disorders, 25 psychoneurotics, 12 schizophrenics, and one with involutional melancholia. Forty-two of the 44 patients had thorough psychiatric follow-up, ranging from one to seven years postoperatively. They were assessed clinically and also on a point-rating scale of assessment.Seventy-six per cent of these patients had excellent or satisfactory outcomes. The most striking benefit was decrease in anxiety and tension.Modified leukotomy is a safe and effective method of reducing the symptoms of excessive tension, anxiety, fear or depression in patients with a variety of illnesses, including anxiety neurosis, phobic psychoneurosis, obsessional neurosis, neurotic or psychotic depressive reactions and schizophrenia. The operation should be considered in such neurotic, personality and psychotic illnesses when medical treatment has failed.