Cranial MR imaging of sequelae of prefrontal lobotomy

Abstract

Background and purpose: Although prefrontal lobotomy is an obsolete treatment for schizophrenia, we still encounter patients who have undergone this procedure. The purpose of this study was to describe the MR imaging findings of sequelae of prefrontal lobotomy.

Methods: We retrospectively reviewed cranial MR images of eight patients with schizophrenia who underwent prefrontal lobotomy approximately 50 years previously.

Results: In all patients, a bilateral cavitary lesion with a thick wall was found in the frontal white matter. The genu of the corpus callosum was mildly to markedly atrophic. The size and location of the cavity and the degree of callosal atrophy were correlated.

Conclusion: MR imaging is useful for the diagnosis of sequelae of prefrontal lobotomy, including cavitary lesions with dense walls of gliosis and secondary degeneration of the genu of the corpus callosum.

fig 1.

Images of patient 4. A, Axial FLAIR image shows a large bilateral cavitary lesion containing CSF-like fluid with a thick wall in the frontal white matter. The cortical sulci of bifrontal lobes are dilated mildly. The cavum septum pellucidum is also observed. B, Midsagittal T1-weighted image shows markedly atrophic genu of the corpus callosum.

fig 2.

Axial FLAIR image of patient 5 shows a small cavity with a thick wall in the bifrontal white matter. The bifrontal cortical sulci are dilated mildly. Moderately atrophic genu of the corpus callosum was observed on the midsagittal T1-weighted image (not shown)

fig 3.

Images of patient 7. A and B, Two contiguous axial FLAIR image shows a small bilateral cavitary lesion in the medial frontal white matter. The cortical sulci of bifrontal lobes are dilated mildly. Markedly atrophic genu of the corpus callosum was observed on the midsagittal T1-weighted image (not shown).