MRI-guided Stereotactic Thalamotomy for Cerebral Palsy Patients of Mixed Dyskinesia

A few neurosurgical alleviate to alleviate some dyskinesias of cerebral palsy(CP) have been tried. For the spastic and tremor type, the selective posterior rhizotomy and thalamotomy are regarded as treatments of choice but other dyskinesias remains a tough challenge. The authors have performed 48 cases of MRI-guided stereotactic thalamotomy(MGST) in 37 CP patients with mixed dyskinesias from Jun. '92 to Jan. '95 using CRW stereotactic frame and MRI, without any ventriculogram. Depending upon the types of main dyskinesias, the target including ventrolateral nucleus of thalamus or medial nucleus of globus pallidus was(were) selected. Clinical results were verified in terms of preoperative symptoms improvement and patient's satisfaction. In athetoid(42 MGSTs in 32CPs) : excellent 6, good 26, fair 10, and in dystonia(30 MGSTs in 23 CPs): excellent 2, good 18, fair 10, and in spasticity(20 in 17 CPs): excellent 3, good 12, fair 5, and in choreoor choreoathetoid(7 in 6 CPs) : good 5, fair 2. Recurrence of symptoms after operation was noted in 6 cases(12.5%). Postoperative morbidity including motor weakness, speech disturbance, swallowing difficulty, and sensory abnormality were transiently noted in 9 cases(18.8%). It is the authors observation that MGST seems to be one of the beneficial procedures for relieving symptoms of CP with mixed dyskinesias.

Intracranial Venous Angioma with Arteriovenous Malformation: Case Report

Intracerebral venous angiomas with arterial components have been reported rarely. A case of venous angioma with arterial component is presented. The patient was a 29-year-old-female who presented with abrupt headache followed by left hemiparesis. Computerized tomography and magnetic resonance imaging revealed intracerebral hematoma in right temporoparietal lobe and basal ganglia with surrounding signal voids. The cerebral angiography showed the characteristic umbrella appearance and single large draining vein of venous angioma in right temporoparietal lobe and fine arterial branches supplying the vascular malformation. At the operation, multiple arteriovenous fistulas without nidus were observed and delicate angiomatous network with red veins were found around the hematoma cavity, Histologic examination of the angiomatous network proved it to be an arteriovenous malformation. It was a variant of mixed angioma, venous angioma combined with arteriovenous malformation. Clinical, angiographic, and pathological features of intracerebral venous angiomas with arterial components were reviewed from literatures.