Orbito-ventromedial undercutting (Hirose), has been performed on fourtythree patients suffering from various mental disorders, and was proved to be a most satisfactory operative method.
Method of operation is as follows: following trephine, white substance directly under the orbital and ventromedial cortex was undercut by suction under direct vision under local anesthesia with 0.5% carbocain-E in almost all cases.
The subjects of the operation comprised eleven cases of schizophrenia, five cases of atypical schizophrenia, six cases of epilepsy with explosive behavior, three cases of manic depressive psychosis, a case of melancholia, four cases of involutional melancholia, two cases of involutional psychosis, four cases of obsessive-conpulsive neurosis, four cases of mental deficiency, two cases of psychopathic personality with explosive behavior and a case of postencephalitic behavior disorder.
1) Side effects due to operation, such as fever, perspiration, leucocytosis, blood concentration, pupillary mios;s, weakness of patellar refrex, hyperesthesia, increased cerebrospinal fluid pressure, were observed to a milder extent than those observed at the time of the other operative methods, and disappeared within two weeks after the operation.
2) Ophthalmoscopic examination revealed swelling and turbidity of both papillary and macular areas in the retina as the sign of slight stimulation, but these signs usually dissappeared within a week after the operation.
3) Postoperative E.E.G. showed a general tendency to bilateral synchronous slow activities of frontal dominance immediately after the operation, but this usually returned to the preoperative pattern within three weeks.
4) The mecholyl test was applied to eleven cases. All cases showed P-type or S-type before the operation, and changes were observed in eight cases into N-type and Pn-type after the operation.
From these observations, it was concluded that the autonomic functions were stabilized by the operation.
Above conclusion was supported by the results of E. E. G. recordings and endocrinological examinations including uropepsin, 17 KS and 17 OHCS determination. Such stabilization of vegetative functions might be related with the working mechanism of this operative procedure on mental disorders.
5) Mental symptoms immediately after the operation include a transient slight somnolent state without obvious disturbance of conciousness, i.e. prompt responsiveness to the surrounding stimuli.
It was followed by a state of so-called“inertia”characterized by impaired concentration and diminished spontaneity in the majority of the cases. Then, one of the following three states appeared in most cases: A) so-called “good humored state”characterized by jocularity; mischievousness, disinhibition, talkativeness and euphoria. B) so-called “ill humored state”characterized by rough attitudes, such as querulousness, moroseness, irritability, agressiveness and violence. C) so-called “mixed state” of A) and B).
These three states were considered to be the release phenomena, and personality of the patients.
Althogh these three states have usually been regarded as symptoms of the lesion in the frontal lobe, other factors have to be considered in view of the increased cerebrospinal fluid pressure and the E. E. G. findings observed in our cases. These mental symptoms disappeared within a month after the operation.
6) After the disappearance of initial symptoms mentioned above, the mental state became stabilized. Psychological testing in this stage revealed no reduction of intelligence, emotional stability, and reduction of anxiety, of depressive mood and inhibi tion, and of oversensitiveness, showing good correlation with the improvement of clinical symptoms.

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