R vanced cancer can be effected by prefrontal lobotomy. A satisfactory "psychosurgery" effect can be produced by fractional injection of physiological saline solution into the frontal lobe. Untoward effects, which may occur during transorbital instrumentatione, 0 or during the injection of procaine or alcohol'@ 8941 7 to produce a frontal lobe interruption, are minimized by the use of saline.
At the Francis Delafield Hospital, New York. N.Y., "saline lobotomy" has replaced surgical lobotomy as a means to provide comfort for terminal patients who no longer obtain pain relief from medication. We have given graded injections of physiological saline into the frontal lobes of 12 patients in the terminal stages of advanced cancer. The resulting spatial destruction of cerebral tissue has uniformly produced a satisfactory lobotomy type o E effect on their pain.@. 10
METHOD
Preoperatively, the patient is evaluated as to type and location of tumor, life expectancy, suitability for other pain relieving procedures such as cordotomy, the type of analgesics being used and their frequency, and the response of the patient as well as his demands, appetite, awareness of surroundings, and interests.
Bifrontal burr holes are made at the level of the coronal suture line 3 cm. from the midline. The dura is opened in a stellate fashion, and the cortical vessels are coagulated. Scalp closure is effected. Penicillin and streptomycin may be given prophylactically during the postoperative period.
Twenty-four to 48 hours after operation, at a time when the patient has pain, the first saline injection is made. The patient lies in bed in his room or ward, and the clean-shaven scalp is prepared with hexachlorophene (pHis@