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Tractotomy is a neurosurgical procedure, the surgical section of a fiber tract of the central nervous system

Subcaudate tractotomy[edit | edit source]

In 1949 Knight at Runwell Hospital started performing the operation of orbital undercutting (called orbital leucotomy in Britain) devised by American surgeon William Beecher Scoville, in which the lower quadrants of the frontal lobes were cut via holes in the forehead.[1] Knight later modified Scoville’s operation to restrict the cut to the lower medial quadrants.[2] Further modifications dating from 1961 included the use of a stereotactic frame and brain images to make it easier to navigate in the frontal lobes, and the use of radioactive seeds (up to 20) to destroy tissue in the subcaudate region.[3] The operation was then called stereotactic subcaudate tractotomy and by the mid 1970s, although only used at two neurosurgical units (which by that time had replaced mental hospitals as the sites for psychosurgical operations), it accounted for 30 per cent of operations in the United Kingdom.[4] Knight operated at the Brook Hospital in South London in collaboration with retired psychiatrist Strom-Olsen and then with psychiatrist Paul Bridges. Knight retired in the early 1970s (the unit was named the Geoffrey Knight psychosurgical unit in his honour) and was replaced by John Bartlett. In all, nearly 1300 subcaudate tractotomies were carried out at the Brook Hospital, with one death attributed wholly to the operation. During the 1980s the unit accounted for over 75 per cent of the psychosurgical operations carried out in Britain.[3] The unit ceased operating in 1994. A team at Kings College Hospital under psychiatrist Stuart Checkley took over the work of the unit and performed 23 stereotactic subcaudate tractotomies over the next five years, using radiofrequency to destroy brain tissue.

See also[edit | edit source]

References[edit | edit source]

  1. GC Knight and RF Tredgold 1955 Orbital leucotomy: a review of 52 cases. The Lancet, 14 May: 981-6.
  2. GC Knight 1960 330 cases of restricted orbital cortical undercutting. Proceedings of the Royal Society of Medicine 53: 728.
  3. 3.0 3.1 PK Bridges et al. 1994 Psychosurgery: stereotactic subcaudate tractotomy, an indispensable treatment. British Journal of Psychiatry 165: 599-611.
  4. JM Barraclough and NA Mitchell-Heggs 1978 Use of neurosurgery for psychological disorder in British Isles during 1974-6. British Medical Journal 2: 1591-3.
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