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Surgeons make a tiny incision behind or through the eyelid, then make a small hole through the eye socket to reach the brain. The new approach, pioneered by surgeons at the University of California, San Diego, and the University of Washington Medical Center, protects important arteries and the nerves for sight and smell, according to a news release from UC San Diego. The new technique -- called transorbital neuroendoscopic surgery, or TONES -- works for patients with cerebral spinal fluid leaks, optic nerve decompression, cranial base fractures and removal of tumors.
The study was published in the September issue of the journal Neurology. (We must admit Boing Boing beat us to writing about the new research, and we must further admit we love the creepy comic they include with their write-up.)
And with a surgery like this one, there's no huge, scary, transcranial scar. In fact, there's no scar at all -- it's a version of the growing number of "natural orifice" surgeries, intended to reduce scars, pain, infection and recover time. Last month, our senior health writer, JoNel Aleccia, wrote about these kinds of surgeries, talking to a San Diego physician who'd removed all kinds of organs from all kinds of places -- including pulling a gallbladder or an appendix out of the mouth, and a weight-loss surgery that removed part of a woman's stomach through her, ah, vagina.
Actually, the whole eye socket thing doesn't sound that bad, after all.
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Hmm... is it just me, or is this reminiscent of the "ice pick lobotomies" of the 40s?
No, it's just you.
No, it's not just BeccaAnne:
Inspired by the work of Italian psychiatrist Amarro Fiamberti, Walter Freeman at some point conceived of approaching the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945 he took an icepick from his own kitchen and began testing the idea on grapefruit and cadavers. This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A mallet was used to drive the leucotome through the thin layer of bone and into the brain. The leucotome was then swept from side to side, thus severing the nerve fibers connecting the frontal lobes to the thalamus. (In a more radical variation, the butt of the leucotome was pulled upward, sending the tip farther back into the brain, producing a "deep frontal cut".) The leucotome was then withdrawn and the procedure repeated on the other side.
Freeman performed the first transorbital lobotomy on a live patient in 1946. Its simplicity suggested the possibility of carrying it out in mental hospitals lacking the surgical facilities required for the earlier, more complex procedure (Freeman suggesting that, where conventional anesthesia was unavailable, electroconvulsive therapy be used to render the patient unconscious).[47] In 1947, the Freeman and Watts partnership ended as the latter was disgusted by Freeman's modification of the lobotomy from a surgical operation into a simple "office" procedure. Between 1940 and 1944, 684 lobotomies were performed in the United States. However, because of the fervent promotion of the technique by Freeman and Watts, those numbers increased sharply towards the end of the decade. In 1949, the peak year for lobotomies in the US, 5,074 procedures were undertaken, and by 1951 over 18,608 individuals had been lobotomised in the US.