Frontal Leukotomy Size and Hemispheric Asymmetries on Computerized Tomographic Scans of Schizophrenics With Variable Recovery

Naeser, Margaret A.

doi:10.1001/archneur.1981.00510010056010

Cited by 68 publications

(15 citation statements)

References 35 publications

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“…Lesion size for this data set was found to be much larger than that of modern lesioning techniques; mean (± standard error) volume was 84.6 ± 1.9 ml. Similar to findings of prior studies, 10,59,61,83 numerous white and gray matter structures were involved in these lesions, including the superior sagittal stratum, anterior thalamic radiations, inferior frontal gyrus, Brodmann areas 44 and 45, cingula, medial orbitofrontal cortex, and dorsolateral prefrontal cortex. Lesioning of these structures probably explains the known side effects of lobotomy, such as emotional flattening, postoperative seizures, and changes to cognitive function and personality.…”

Section: Discussionsupporting

confidence: 87%

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Yang

Ginat

Dougherty

et al. 2014

JNS

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Object Cingulotomy and limbic leucotomy are lesioning surgeries with demonstrated benefit for medically intractable psychiatric illnesses. They represent significant refinements of the prefrontal lobotomy used from the 1930s through the 1950s. However, the associations between anatomical characterization of these lesions and outcome data are not well understood. To elucidate these procedures and associations, the authors sought to define and compare the neuroanatomy of cingulotomy and limbic leucotomy and to test a method that uses neuroanatomical data and voxel-based lesion–symptom mapping (VLSM) to reveal potential refinements to modern psychiatric neurosurgical procedures. Methods T1-weighted MR images of patients who had undergone cingulotomy and limbic leucotomy were segmented and registered onto the Montreal Neurological Institute T1-weighted template brain MNI152. Using an atlas-based approach, the authors calculated, by case, the percentage of each anatomical structure affected by the lesion. Because of the infrequency of modern lesion procedures and the requirement for higher-resolution clinical imaging, the sample size was small. The pilot study correlated cingulotomy and limbic leucotomy lesion characteristics with clinical outcomes for patients with obsessive-compulsive disorder. For this study, preoperative and postoperative Yale-Brown Obsessive Compulsive Scale scores for 11 cingulotomy patients and 8 limbic leucotomy patients were obtained, and lesion masks were defined and compared anatomically by using an atlas-based method. Statistically significant voxels were additionally calculated by using VLSM techniques that correlated lesion characteristics with postoperative scores. Results Mean lesion volumes were 13.3 ml for cingulotomy and 11.8 ml for limbic leucotomy. As expected, cingulotomy was isolated to the anterior cingulum. The subcaudate tractotomy portion of limbic leucotomy additionally affected Brodmann area 25, the medial orbitofrontal cortex, and the nucleus accumbens. Initial results indicated that the dorsolateral regions of the cingulotomy lesion and the posteroventral regions of the subcaudate tractotomy lesion were associated with improved postoperative Yale-Brown Obsessive Compulsive Scale scores. Conclusions Cingulotomy and limbic leucotomy are lesioning surgeries that target pathological circuits implicated in psychiatric disease. Lesion analysis and VLSM contextualize outcome data and have the potential to be useful for improving lesioning neurosurgical procedures.

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Section: Discussionsupporting

confidence: 87%

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Yang

Ginat

Dougherty

et al. 2014

JNS

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“…Subsequently, Naeser et al (1981) and Tsai et al (1983) reported reversals of asymmetry in the occipital but not the frontal lobe, and Luchins et al (1981) replicated their earlier finding of reversal of occipital lobe asymmetry. However, the situation became much less clear as a number of negative reports began to appear (Andreasen et al 1982;Jemigan et al 1982;Nyback et al 1982;Weinberger et al 1982;Luchins and Meltzer 1983).…”

Section: Schizophreniasupporting

confidence: 66%

Structural Asymmetries of the Human Brain and Their Disturbance in Schizophrenia

Petty

1999

Schizophrenia Bulletin

110

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Asymmetries of the brain have been known about for at least a century, but they have been explored in detail only relatively recently. It has become clear that, although different asymmetries are common throughout the animal kingdom, they are most marked in the human brain. Disturbances in asymmetry are particularly striking in patients with schizophrenia and perhaps all psychotic illnesses, and may provide the neurological substrate for the etiology and clinical manifestations of the illness.

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“…Luchins et al (1979) first reported that the pattern of hemispheric asymmetry normally detected by computed tomography (CT) (right hemisphere greater in size than the left; R > L) was reversed in schizophrenics. This result was confirmed by some subsequent CT studies (Naeser et al 1981;Luchins et al 1982;Nyback et al 1983;Tsai et al 1983), but not by all; several groups reported no difference in cranial or hemispheric asymmetry between schizophrenics and controls (Andreasen et al 1982;Jernigan et al 1982;Weinberger et al 1982). Reviewing these findings, Tsai et al (1983) attributed some of the discrepancy to heterogeneous patient and control groups, and to the inconsistency of methods used for quantification of asymmetry.…”

Section: Cerebral Hemispheric Asymmetrymentioning

confidence: 79%

Cerebral hemispheric asymmetry revisited: effects of handedness, gender and schizophrenia measured by radius of gyration in magnetic resonance images

et al. 1995

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SynopsisAbnormal patterns of cerebral hemispheric asymmetry have been inconsistently reported in association with schizophrenia. Radius of gyration (Rg) is a measure of the mean dispersion of points in a radially organized structure about that structure's centre of gravity. We developed computerized methods for estimating Rg of the magnetic resonance image (MRI) boundary between cortex and subcortex, and applied these methods to measurement of cerebral hemispheric asymmetry in 37 schizophrenics (SZs) and 30 controls (CONs). In right-handed CONs, Rg of right brain boundaries was significantly greater than Rg of left brain boundaries; in left-handed CONs, Rg of left brain boundaries was significantly greater than Rg of right brain boundaries. In right-handed males (both SZ and CON), there were significant differences in Rg between hemispheres; whereas in females (both SZ and CON) there were no such differences. Right-handed male SZs (N = 26) were distinguished by reversal of the right-handed male CON pattern of interhemispheric difference in Rg, and by global reduction in Rg of right brain boundaries. There was no evidence for significant abnormality of Rg in right-handed female SZs (N = 7). These findings suggest an important interactive effect of gender and schizophrenia on lateralized cerebral structure.

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Frontal Leukotomy Size and Hemispheric Asymmetries on Computerized Tomographic Scans of Schizophrenics With Variable Recovery

Cited by 68 publications

References 35 publications

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Structural Asymmetries of the Human Brain and Their Disturbance in Schizophrenia

Cerebral hemispheric asymmetry revisited: effects of handedness, gender and schizophrenia measured by radius of gyration in magnetic resonance images

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