Subcorticotomia do lobo orbitário e distúrbios instintivos

Treatment of instinctive disturbances with orbital undercutting

Resumos

Os autores apresentam quatro casos de pacientes operados pela técnica de Scoville (subcorticotomia do lobo orbitário), a saber: dois deficientes mentais com exaltação sexual, um esquizofrênico crônico com exaltação sexual e grande agressividade e um jovem de 16 anos com graves distúrbios de conduta, especialmente nos setores da agressividade e sexo. A base teórica para tal indicação foram as idéias de Kleist e A. Silveira sôbre a psicofisiologia do lobo orbitário. Os resultados foram tão nítidos que autorizam a comunicação dêste trabalho, embora com escassa casuística. Houve normalização parcial da conduta nos 4 pacientes. Inesperadamente, o efeito sôbre o setor sexual mostrou evidente correlação com a intervenção praticada à esquerda, ao passo que a subcorticotomia à direita influiu especialmente sôbre as atitudes agressivas.


Four cases operated by the Scoville technique (orbital undercutting) are reported namely: two patients with mental deficiency and sexual exaltation, one with chronic schizophrenia and sexual exaltation and great agressivity, a boy sixteen years old presenting severe behaviour disturbances, specially on the sexual sphere, with agressivity. The theoretical basis for such an operation are based on Kleist's and Aníbal Silveira's ideas upon the psychophysiology of the orbital lobe. The end-results of the operation were satisfactory; there was a partial normalization of behaviour in the four patients. Unexpectadly the effect upon the sexual behaviour showed an evident correlation following the intervention on the left side, while the orbital undercutting on the right side has an effect specially concerning the agressive behaviour.


Spartaco VizzottoI; Isaías MelsohnI; Afonso Sette JuniorI; Aloysio Mattos PimentaII; Paulo Mangabeira Albernaz FºII; Roberto TomchinskyI; Luiz J. A. FioreI

IMédicos do Hospital de Juqueri

IINeurocirurgiões da Escola Paulista de Medicina (Prof. Paulino Longo)

RESUMO

Os autores apresentam quatro casos de pacientes operados pela técnica de Scoville (subcorticotomia do lobo orbitário), a saber: dois deficientes mentais com exaltação sexual, um esquizofrênico crônico com exaltação sexual e grande agressividade e um jovem de 16 anos com graves distúrbios de conduta, especialmente nos setores da agressividade e sexo.

A base teórica para tal indicação foram as idéias de Kleist e A. Silveira sôbre a psicofisiologia do lobo orbitário. Os resultados foram tão nítidos que autorizam a comunicação dêste trabalho, embora com escassa casuística. Houve normalização parcial da conduta nos 4 pacientes.

Inesperadamente, o efeito sôbre o setor sexual mostrou evidente correlação com a intervenção praticada à esquerda, ao passo que a subcorticotomia à direita influiu especialmente sôbre as atitudes agressivas.

SUMMARY

Four cases operated by the Scoville technique (orbital undercutting) are reported namely: two patients with mental deficiency and sexual exaltation, one with chronic schizophrenia and sexual exaltation and great agressivity, a boy sixteen years old presenting severe behaviour disturbances, specially on the sexual sphere, with agressivity. The theoretical basis for such an operation are based on Kleist's and Aníbal Silveira's ideas upon the psychophysiology of the orbital lobe.

The end-results of the operation were satisfactory; there was a partial normalization of behaviour in the four patients. Unexpectadly the effect upon the sexual behaviour showed an evident correlation following the intervention on the left side, while the orbital undercutting on the right side has an effect specially concerning the agressive behaviour.

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REFERÊNCIAS

1. BONNER, F.; COBB, S.; SWEET, W. H.; WHITE, J. C. - Frontal lobe surgery in treatment of pain with considerations of post-operative psychological changes. Psychosom. Med., 14:383-405, 1952.

2. DAVIS, H. W.; EAST, I. C; TAIT, H. S.; JOHNSON, S. C; ROGERS, W. B. - West Virginia lobotomy project. J.A.M.A., 156: 939-943, 1954.

3. DAX, E.; RADLEY-SMITH, E. J. - Prefrontal leucotomy. Digest Neurol, a. Psychiat., 16:533-550, 1948.

4. KLEIST, K. - Discussion des rapports sur l'anatomo-physiologie cérébrale à la lumière des lobotomies et topectomies. Comptes Rendus du Premier Congrès Mondial de Psychiatrie (Paris) 3:59-64, 1952.

5. LASHLEY, K. S. - Coalescence of Neurology and Physiology. Proc. Am. Philos. Soc, 84:461-470, 1941.

6. RUCH, T. C; SHENKIN, H. A. - The relation of area 13 on orbital surface of frontal lobes to hyperactibility and hyperphagia in monkeys. J. Neurophysiol., 6:349-360, 1943.

7. RYLANDER, G. - Relief of symptoms and personality changes after superior convexity and orbital undercutting. Anais V Congresso Internacional de Neurologia (Lisboa) 2:213-214, 1953.

8. SCOVILLE, W. B. - a) Selective cortical undercuting as a means of modifying and studying frontal lobe function in man. J. Neurosurg., 6:65-74, 1949; b) Orbital undercutting in the treatment of psychoneurosis, depressions and senile emotional states. Dis. Nervous System, 15:324-334, 1954.

9. SCOVILLE, W. B.; DUNA MORE, R. H.; LIBERSON, W. T.; HENRI, C. E.; PEPE, A. - Observations on medial temporal lobotomy and uncotomy in the treatment of psychotic states; preliminary review of 19 operative cases compared with 60 frontal lobotomy and undercutting cases. Res. Publ. Ass. Nerv. Ment. Dis., 31:347-373, 1952.

10. SCOVILLE, W. B.; WILK, E. K.; PEPE, A. J. - Selective cortical undercutting: Results in new method of fractional lobotomy. Am. J. Psychiat., 107:730-737, 1951.

11. SILVEIRA, A. - Discussion des rapports sur l'anatomo-physiologie cérébrale à la lumière des lobotomies et topectomies. Comptes Rendus du Premier Congrès Mondial de Psychiatrie (Paris) 3:86-95, 1952.

12. STROM-OLSEN, R.; NORTHFIELD, D. W. C. - Undercutting of orbital cortex in chronic neurotic and psychotic tension states. Lancet, 269:986-991, 1955.

13. TURNER, E. A. - The Future of Psychosurgery. Birmingham M. Rev., 18:85-103, 1953.

14. VIZZOTTO, S.; PIMENTA, A. M. - La physiopathologie du lobe orbitaire dans son rapport avec la leucotomie. Comptes Rendus du Premier Congrès de Psychiatrie (Paris) 3:148-156, 1952.

Trabalho realizado no Hospital de Juqueri, apresentado ao V Congresso Brasileiro de Psiquiatria, Neurologia e Higiene Mental (julho de 1958, Salvador - Bahia).

Hospital de Juqueri - Franco da Rocha - São Paulo, Brasil.

  • 1. BONNER, F.; COBB, S.; SWEET, W. H.; WHITE, J. C. - Frontal lobe surgery in treatment of pain with considerations of post-operative psychological changes. Psychosom. Med., 14:383-405, 1952.
  • 2. DAVIS, H. W.; EAST, I. C; TAIT, H. S.; JOHNSON, S. C; ROGERS, W. B. - West Virginia lobotomy project. J.A.M.A., 156: 939-943, 1954.
  • 3. DAX, E.; RADLEY-SMITH, E. J. - Prefrontal leucotomy. Digest Neurol, a. Psychiat., 16:533-550, 1948.
  • 4. KLEIST, K. - Discussion des rapports sur l'anatomo-physiologie cérébrale à la lumière des lobotomies et topectomies. Comptes Rendus du Premier Congrès Mondial de Psychiatrie (Paris) 3:59-64, 1952.
  • 5. LASHLEY, K. S. - Coalescence of Neurology and Physiology. Proc. Am. Philos. Soc, 84:461-470, 1941.
  • 6. RUCH, T. C; SHENKIN, H. A. - The relation of area 13 on orbital surface of frontal lobes to hyperactibility and hyperphagia in monkeys. J. Neurophysiol., 6:349-360, 1943.
  • 7. RYLANDER, G. - Relief of symptoms and personality changes after superior convexity and orbital undercutting. Anais V Congresso Internacional de Neurologia (Lisboa) 2:213-214, 1953.
  • 8. SCOVILLE, W. B. - a) Selective cortical undercuting as a means of modifying and studying frontal lobe function in man. J. Neurosurg., 6:65-74, 1949;
  • b) Orbital undercutting in the treatment of psychoneurosis, depressions and senile emotional states. Dis. Nervous System, 15:324-334, 1954.
  • 9. SCOVILLE, W. B.; DUNA MORE, R. H.; LIBERSON, W. T.; HENRI, C. E.; PEPE, A. - Observations on medial temporal lobotomy and uncotomy in the treatment of psychotic states; preliminary review of 19 operative cases compared with 60 frontal lobotomy and undercutting cases. Res. Publ. Ass. Nerv. Ment. Dis., 31:347-373, 1952.
  • 10. SCOVILLE, W. B.; WILK, E. K.; PEPE, A. J. - Selective cortical undercutting: Results in new method of fractional lobotomy. Am. J. Psychiat., 107:730-737, 1951.
  • 11. SILVEIRA, A. - Discussion des rapports sur l'anatomo-physiologie cérébrale à la lumière des lobotomies et topectomies. Comptes Rendus du Premier Congrès Mondial de Psychiatrie (Paris) 3:86-95, 1952.
  • 12. STROM-OLSEN, R.; NORTHFIELD, D. W. C. - Undercutting of orbital cortex in chronic neurotic and psychotic tension states. Lancet, 269:986-991, 1955.
  • 13. TURNER, E. A. - The Future of Psychosurgery. Birmingham M. Rev., 18:85-103, 1953.
  • 14. VIZZOTTO, S.; PIMENTA, A. M. - La physiopathologie du lobe orbitaire dans son rapport avec la leucotomie. Comptes Rendus du Premier Congrès de Psychiatrie (Paris) 3:148-156, 1952.

  • Subcorticotomia do lobo orbitário e distúrbios instintivos
    Treatment of instinctive disturbances with orbital undercutting

Datas de Publicação

  • Publicação nesta coleção
    11 Dez 2013
  • Data do Fascículo
    Jun 1959
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