A portrait of prefrontal lobotomy performed at the Royal Prince Alfred Hospital in Sydney by Dr Rex Money.

OBJECTIVE: The objective of this article is to provide a portrait of prefrontal lobotomy performed at the Royal Prince Alfred Hospital, Sydney by the Head of Neurosurgery Dr Rex Money and to describe Dr Money's role in the promotion of psychosurgery in Sydney. METHODS: We draw attention to an oral presentation by Dr Rex Money in 1951, a journal article written by Money, archival information held at the Royal Prince Alfred Hospital, including Dr Money's accounts of his travels and his reports regarding neurosurgery - both internationally and in Australia. RESULTS: Dr Rex Money performed a series of 13 prefrontal lobotomies between 1945 and 1951, and presented the theoretical basis for his series, his operative procedures and the outcomes at the annual meeting of its medical officers' association. CONCLUSION: Notwithstanding various deficiencies in his clinical research, Money's descriptions give a relatively comprehensive account of one of the first series of prefrontal lobotomies performed in Australia. The current article also describes Dr Money's contributions to the promotion of psychosurgery in Sydney, and illustrates the participation of a senior neurosurgeon and of a major Sydney teaching hospital during the psychosurgery saga.

The advent of psychosurgery in Australia-with particular attention to its introduction into Sydney.

OBJECTIVE: The objective of this study was to describe the advent of prefrontal lobotomy in Sydney and, less comprehensively, its introduction into Australia. METHOD: Reference to journal articles, books, reports and archival data held at the Royal Prince Alfred Hospital and via internet searches, interviews and personal memory. RESULT: This paper describes the arrival of psychosurgery in Sydney in the mid-1940s, and less comprehensively, its arrival in other Australian cities. CONCLUSIONS: In New South Wales, from 1945 or 1946, prefrontal lobotomies were conducted in private clinics and in public hospitals but, because of legal and practical hurdles, it is unlikely that psychosurgery was performed in mental hospitals prior to December 1958. This paper gives some details regarding the participation of neurosurgeons and of the major public hospitals in psychosurgery, and touches on the attitudes within the Australian medical profession towards this dramatic new therapy.

A rare presentation of pigmented villonodular synovitis.

Tenosynovial giant cell tumours are of two types, localised and diffuse. The diffuse type is also known as pigmented villonodular synovitis (PVNS). There have been 42 previously reported cases of PVNS in the axial skeleton, seven of which were reported in the thoracic spine. A young patient found to have thoracic PVNS and who presented with progressive lower limb weakness and parasthesiae over 3 weeks is reported. Computed tomography and magnetic resonance imaging demonstrated a posterior lesion at T6/7 with local bone invasion. The patient underwent complete resection of the tumour and has had an unremarkable postoperative convalescence with resolution of his signs and symptoms. Total surgical resection is the treatment of choice for this condition and close postoperative follow-up with serial imaging is important to monitor for local recurrence.

Late quadriplegia after adult coarctation repair.

Quadriplegia developed suddenly 1 month after coarctation repair in a 53-year-old human. Cervical cord ischemia caused by thrombosis in an enlarged anterior spinal artery collateral was diagnosed on magnetic resonance scan and spinal angiography. After urgent cord decompression and anticoagulation there was neurologic improvement over a period of several months. Urgent investigation of neurologic abnormalities occurring late after coarctation repair may enable intervention to avert permanent neurologic sequelae.

The efficacy of antiepileptic drug prophylaxis in the prevention of early and late seizures following repair of intracranial aneurysms.

The efficacy of antiepileptic drug (AED) prophylaxis in patients undergoing aneurysm repair has been questioned, yet these drugs are routinely used in many institutions. To better define the relationship of AED prophylaxis to postoperative seizures, we undertook a review of 259 patients undergoing treatment for intracranial aneurysms. Incidence of late seizures was assessed by telephone interview in 132 patients (mean follow-up, 58.7 months). There were seven early seizures, all in patients who received AED prophylaxis (higher versus [vs.] no prophylaxis, p=0.019). There were 12 late seizures (nine with prophylaxis vs. three without prophylaxis, p=0.53). The timing of AED prophylaxis had no effect on the incidence of early or late seizures in either group. AED use was associated with an increased rate of early seizures. Postoperative seizures remain important adverse outcomes following aneurysm repair, but despite their traditional role, the routine use of AED should be reconsidered carefully.