Selective Cortical Undercutting As a Means of Modifying and Studying Frontal Lobe Function in Man

Preliminary Report of Forty-Three Operative Cases

Restricted access

If the inline PDF is not rendering correctly, you can download the PDF file here.

The physiological function of the frontal lobe in man still remains an uncharted field. A technique of cortical undercutting has been devised to enable one to detach certain areas of the frontal cortex by making a line of cleavage at the relatively avascular junction of gray and white matter by means of a suction tip and spatula, thus interrupting the long association fibers of the overlying cortex. The short U association fibers to adjacent gyri are interrupted by angling the undercutting superficially into the gray matter at the peripheral borders of the area to be isolated. Cortical undercutting

Article Information

56 Garden Street, Hartford 5, Connecticut.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Instruments used in cortical undercutting.

  • View in gallery

    Location of trephines in undercutting of Broadmann's areas 9 and 10. Solid lines indicate dural incisions. Dotted lines indicate area of undercutting.

    Postmorten brain showing cortical incisions used in undercutting of partial Broadmann's areas 9 and 10. White strips mark the location of cortical incisions as used in orbital and cingulate gyrus undercuttings.

    Undercutting of Broadmann's areas 9 and 10 over superior convexity and medial surface.

  • View in gallery

    Vertical cross sections of right frontal lobe demonstrating anterior and posterior levels of undercutting of Brodmann's areas 9 and 10. In this case a more radical undercutting was done for intractable pain, and includes a deeper area extending 1.5 cm. farther laterally and 1 cm. deeper medially than in the 42 other cases reported in this paper.

    Lateral stereoscopic x-ray to show wire markers outlining the undercutting of areas 9 and 10.

  • View in gallery

    Location of trephines for undercutting of the orbital surface.

    Orbital undercutting over orbital surface.

  • View in gallery

    Lateral x-ray to show wire markers in orbital undercutting.

  • View in gallery

    Location of trephines for undercutting of medial surface and cingulate gyrus.

    Area of undercutting largely limited to anterior cingulate gyrus (area 24) and also area 32 of Brodmann.

  • View in gallery

    Lateral x-ray to show wire markers extending posteriorly to include the entire anterior cingulate gyrus both above and below the corpus callosum for a distance of 3 cm. from the anterior edge of the genu.

References

1.

BaileyP. and SweetW. H. Effects on respiration, blood pressure and gastric motility of stimulation of orbital surface of frontal lobe. J. Neurophysiol.19403: 276281.Bailey P. and Sweet W. H. Effects on respiration blood pressure and gastric motility of stimulation of orbital surface of frontal lobe. J. Neurophysiol. 1940 3: 276–281.

2.

Columbia-Greystone Associates. Problems of the human frontal lobe. (Pre- and post-operative studies of a group of psychotic patients from whom various portions of both frontal lobes were surgically removed. Presented before New York Academy of MedicineMarch 18–19, 1948.Columbia-Greystone Associates. Problems of the human frontal lobe. (Pre- and post-operative studies of a group of psychotic patients from whom various portions of both frontal lobes were surgically removed. Presented before New York Academy of Medicine March 18–19 1948.

3.

FreemanW. Transorbital lobotomy. Preliminary report of ten cases. Med. Ann. Distr. Columbia194817: 257261.Freeman W. Transorbital lobotomy. Preliminary report of ten cases. Med. Ann. Distr. Columbia 1948 17: 257–261.

4.

FultonJ. F. The surgical approach to mental disorder. McGill med. J.194817: 133145.Fulton J. F. The surgical approach to mental disorder. McGill med. J. 1948 17: 133–145.

5.

LivingstonR. B.FultonJ. F.DelgadoJ. M. R.SachsE.Jr.BrendlerS. J. and DavisG. D. Stimulation and regional ablation of orbital surface of frontal lobe. Res. Publ. Ass. nerv. ment. Dis.194827: 405420.Livingston R. B. Fulton J. F. Delgado J. M. R. Sachs E. Jr.Brendler S. J. and Davis G. D. Stimulation and regional ablation of orbital surface of frontal lobe. Res. Publ. Ass. nerv. ment. Dis. 1948 27: 405–420.

6.

PenfieldW.CameronD. E.PradosM. D. and MalmoR. B. Symposium on gyrectomy. Res. Publ. Ass. nerv. ment. Dis.194827: 519564.Penfield W. Cameron D. E. Prados M. D. and Malmo R. B. Symposium on gyrectomy. Res. Publ. Ass. nerv. ment. Dis. 1948 27: 519–564.

7.

WalkerA. E. A cytoarchitectural study of the prefrontal area of the Macaque monkey. J. comp. Neurol.194073: 5986.Walker A. E. A cytoarchitectural study of the prefrontal area of the Macaque monkey. J. comp. Neurol. 1940 73: 59–86.

8.

WardA. A.Jr. The anterior cingulate gyrus and personality. Res. Publ. Ass. nerv. ment. Dis.194827: 438445. Also personal communication.Ward A. A. Jr. The anterior cingulate gyrus and personality. Res. Publ. Ass. nerv. ment. Dis. 1948 27: 438–445. Also personal communication.

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 15 15 6
Full Text Views 211 211 75
PDF Downloads 46 46 5
EPUB Downloads 0 0 0

PubMed

Google Scholar