24/10/2025
🧠 Transorbital lobotomy 🧠
Developed by neurologist Walter Freeman in the United States. First performed in 1946 following the earlier prefrontal lobotomy pioneered by egas moniz in 1935.
The procedure entered through the superior orbital fissure behind the eyelid using a thin instrument known as the orbitoclast. A mallet was used to pe*****te the orbit and reach the white matter of the frontal lobes. The intent was to disrupt connectivity between the thalamus and prefrontal cortex, regions involved in emotional regulation and executive function.
By 1949, more than 18,000 lobotomies had been conducted in the states. Patients were treated for schizophrenia, severe depression, bipolar disorder, obsessive compulsive disorder and behavioural disorders. It was performed without craniotomy and often without general anaesthesia. Freeman’s records report up to 25 procedures in one day.
Mid-century psychiatric data recorded reduced agitation and self-harm behaviours in some patients. Many experienced apathy, loss of initiative, disinhibition, urinary incontinence, seizures and long-term cognitive impairment. Mortality was estimated between 5 and 15 percent, most commonly due to intracerebral haemorrhage, infection or brain herniation.
The adoption of chlorpromazine in 1954, rising ethical concerns and advanced understanding of frontal lobe circuitry resulted in the decline and cessation of transorbital lobotomy, identified to cause catastrophic and permanent structural and functional damage to the dorsolateral prefrontal cortex and orbitofrontal cortex.