Medicine: Rear Entrance

Brain surgery is a tempting way to tackle insanity. When it works, the results are quick and dramatic. Recently surgeons have been concentrating on the front part of the brain, isolating the frontal lobe from the rest of the brain (prefrontal lobotomy), or cutting part of it out (topectomy). Trying a new approach, Vienna-born Neurologist Ernest A. Spiegel and Brain Surgeon Henry T. Wycis, both of Philadelphia’s Temple University, decided to work on the thalamus, at the base of the brain.

The thalamus, a sort of relay station, transmits nerve impulses to & from the frontal lobe. When these nerve pathways get out of whack, the doctors reasoned, emotional control becomes disturbed and insanity results. Why not operate on the thalamus direct instead of risking damage to the frontal lobe? The big difficulty was getting at the thalamus without wrecking three inches of brain on the way.

First the doctors invented a new instrument, which they called a stereo-encephalotome. It is about a foot high, and looks like a surveyor’s transit; its four legs are mounted on a ring fixed to the patient’s skull by a plaster cast. At the top is a hollow needle containing a fine electric wire. X-ray pictures are taken to establish the exact position of the thalamus; the legs of the instrument are adjusted to place the needle exactly over it. The patient is anesthetized, and a piece of bone directly under the needle is cut out by conventional surgery. Then the needle is lowered like a well-digger’s rig into the thalamus, and the searing electric current turned on. After a year’s experiments with animals, Drs. Spiegel and Wycis were ready for their first human patients. Last week they announced first results of their new operation, called thalamotomy.

The operation has been performed on 14 patients. All were schizophrenics, manic-depressives, or psychoneurotics in obsessive states. In the first three cases the technique was not perfected, and there was no improvement. The last three operations were too recent to test results. Of the other eight, one died; three are still in institutions; four improved enough to return home, one enough to get a job (as a farm worker).

Comparing their operation with topectomy, the Temple doctors point out that none of their patients has become childish, undisciplined, or had epileptic-like convulsions. They are not yet ready to draw final conclusions, but believe that thalamotomy has proved its ability to “produce definite changes in personality and to relieve anxiety, emotional tension and allied symptoms.”