Prefrontal leucotomy, also known as prefrontal lobotomy, is an obsolete treatment for schizophrenia and other neuropsychiatric conditions, whereby the white matter tracts of the frontal lobes were interrupted surgically via bilateral frontal burr holes.
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Radiographic features
CT and MRI
The prefrontal lobotomy is represented by symmetrical white matter cavitary lesions in the anterior portion of the frontal lobes. MRI is more effective than CT in the diagnosis of prefrontal lobotomy and its secondary degenerations 1.
The loss of injured tissue secondary to prefrontal lobotomy results in bilateral cavitary lesions with fan-like shapes that are surrounded by dense gliosis, which is best seen as hyperintense unenhanced surrounding areas on FLAIR. CT scans reveal that these lesions are CSF attenuation cavities 1.
History and etymology
Prefrontal leucotomy was developed in 1935 by Antonio Egas Moniz, a Portuguese neurologist. In retrospect, his greatest contribution to radiology and medicine was his development of cerebral angiography in 1927 2.
This psychosurgery produced a good therapeutic response and, in 1949, Egas Moniz won the Nobel Prize in Medicine or Physiology for his discovery 2. The popularity of prefrontal lobotomy decreased during the 1960s after the development of effective psychopharmacologic agents, including chlorpromazine, for the treatment of mental diseases 1.
Differential diagnosis
sequelae of old contusions: both cerebral cortex and white matter are damaged in these cases; in the case of prefrontal lobotomy, lesions do not involve the cortex except for the needle entry site 1
bilateral border zone (watershed) infarctions between the anterior and middle cerebral arteries: border zone infarctions usually have their maximum diameters in the anteroposterior directions, and central cavities are rarely seen 1
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