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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Hypothalamotomy in a sexually deviated patient: MRT-based verification of the lesion after 34 years

Meeting Abstract

  • Sebastian Payer - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Hans-Dieter Timmann, Ann-Freya Förster - Klinik für Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Manfred Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Dieter Müller - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
  • Wolfgang Hamel - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1882

DOI: 10.3205/10dgnc353, URN: urn:nbn:de:0183-10dgnc3537

Published: September 16, 2010

© 2010 Payer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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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.