gms | German Medical Science

Objective: In the 1970-ies hypothalamotomies have been performed in selected clinical centres in Germany and Slovakia for the treatment of deviant sexual behaviour. Roeder has described the target in the anterior hypothalamus in animal studies. At that time imaging was done by ventriculography and the location of the lesion could not be verified by any anatomic imaging.

Methods: We re-examined a patient operated in 1976 and performed MR-imaging (1.5 Tesla Siemens, T1-weighted mpr, 1 mm voxel sz.) to show the location and extent of the hypothalamic lesion. Surgery had been performed because of repeated rape on women. Although he never abused children he mentioned a paedophile tendency toward male children. Due to the severe psychological strain it was his personal wish to be operated on. At the time of MR-imaging we also performed an open interview.

Results: The clinical outcome in this patient has been described in detail in the thesis of one of the authors. In addition the performing stereotactic surgeon saw the patient on several occasions in the last decades. The patient is married, has two children and a prosperous professional career, thus having a successful social reintegration. As often observed in conjunction with this procedure the patient gained weight (BMI 29) but was stable for at least 10 years. The MRI revealed a very small lesion in the right anterior hypothalamus for which only indirect signs have been found such as an asymmetric widening ("e vacuo") of the third ventricle on the right side.

Conclusions: A lesion in the anterior hypothalamus placed several decades ago for treating deviant sexual behaviour has been re-examined here for the first time by using modern MR-imaging. The re-examination was augmented by a detailed interview with the patient. The ethical implications of these procedures may need to be revisited with dramatically increased imaging capabilities and knowledge of the correlative neuroanatomical basis of neuropsychology.