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The author, professor of neurology in Lisbon, sees an affective surgical treatment in certain psychoses (schizophrenia included) by the interruption of the connecting fibers between cells of the prefrontal area and other regions of the brain. At first his procedure consisted in the injection of alcohol into the subcortical white matter of the prefrontal area but later on he used a leucotome with a steel band that cuts the brain substance.
The trephine openings are made about 1-1 1/2 cm. in front of a vertical line passing through the base of the tragus, and 3 cm. to each side of the midsagittal line. The leucotome enters to a depth of 4 1/2 cm. in an anterolateral direction. After the loop is opened, the leucotome is turned so as to cut a core about 1 cm. in diameter in the parenchyma. After the blade is retracted, the leucotome is withdrawn 1 cm. A second core is cut at 3 1/2 cm. and then a third one at 2 1/2 cm. from the surface of the brain. Then the leucotome is withdrawn entirely. Then it is reintroduced in an anteromesial direction to a depth of 4 cm., withdrawn 1 cm. to cut