Cerebral Effects of Stereotactic Subcaudate Tractotomy

Abstract

The psychosurgical operation of stereotactic subcaudate tractotomy (SST) is performed for patients who have treatment resistant affective illness refractory to electroconvulsive therapy (ECT) and vigorous pharmacotherapy (Bartlett et al. 1981). The operation consists of placing ten yttrium-90 rods, 7mm long by 1 mm in diameter, in the ventroposterior quadrant of the frontal lobes. They are placed stereotactically using a Macaul frame by taking repeat anteroposterior and lateral air ventriculograms and hence calculating the siting. Some 60% of patients get well either on or off medication; the response is slow, requiring 3–12 months. Some 20 patients from the whole UK are operated on every year. There are no major adverse personality changes (Goktepe et al. 1975). This pilot study was undertaken to determine the precise siting of the lesion, the effects of the operation on the brain at various postoperative times and the optimal time intervals for magnetic resonance imaging (MRI) of the patients postoperatively.