ABSTRACT
Experience with 366 CT-stereotactic operations in varying movement disorders (Parkinson's disease, cerebral palsy, torsion dystonia, torticollis, hemihyperkinesis) is presented. Different deep structures, such as thalamic nuclei, subthalamic structures, palladium, putamen, caudate nucleus, dentate nucleus, and brachium conjunctivum or combination of these structures, were selected as a stereotactic target point. Anodic or radiofrequency stimulation, implantation of chronic intracerebral electrodes and neurotransplantation were used as methods of exposure. A procedure for CT-stereotactic determination of supratentorial and subtentorial target points is described. CT-guided stereotactic procedures in the treatment of dyskinesia are precise and less traumatic than ventriculography-guided procedures.
Subject(s)
Intraoperative Care , Movement Disorders/diagnostic imaging , Movement Disorders/surgery , Stereotaxic Techniques , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Brain/diagnostic imaging , Brain/surgery , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Stereotaxic Techniques/instrumentation , Tomography, X-Ray Computed/instrumentationABSTRACT
To facilitate a full-scale representation of thalamic nuclei and surrounding subcortical structures in the course of stereotactic procedures, a 3-D computer atlas of this region has been created, which permits visualization of the operative field including the involved structures and the position of the instrument. Necessary adaptation is performed according to the position of the intracranial reference points derived from CT-scan. Working with the atlas permitted more accurate and safer surgery. An IBM PC/AT computer was used.
Subject(s)
Parkinson Disease/surgery , Stereotaxic Techniques , Thalamic Nuclei/surgery , Tomography, X-Ray Computed/instrumentation , Adult , Atlases as Topic , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Parkinson Disease/pathology , Thalamic Nuclei/anatomy & histology , Tremor/pathology , Tremor/surgeryABSTRACT
Responses of 340 single units of the n. Rt of the human thalamus to significant and insignificant verbal and sensory stimuli during the performance of voluntary motor acts recorded by microelectrodes were investigated in dyskinetic patients in the course of 46 stereotaxic operations. Two types of polymodal units with irregular continuous (A-type, "triggered verbal command" units, 183 neurons, 56% reacting) and burst rhythmic (2-5 per s.) discharges (B-type, 139 neurons, 59% reacting) have revealed reactivity to a verbal command with a specialized multicomponent pattern at functionally different stages of purposive motor acts. The analysis of principal components has shown that the extracted components of responses correlated with the functional significance of verbal or sensory signals, especially with voluntary acts of the verbal message triggering, but not with physical, somatotopic or semantic parameters of stimulation. It was suggested that the transient time-connectivity of A and B neurons at the trigger stages of purposive tasks reflected the coexistence in the Rt of two functionally different cellular subsystems participating in the transmission of significant signals during speech-provoked voluntary acts.
Subject(s)
Neurons/physiology , Sensation/physiology , Thalamic Nuclei/physiology , Verbal Behavior/physiology , Acoustic Stimulation , Electroencephalography , Electromyography , Electrooculography , Evoked Potentials, Auditory/physiology , Humans , Microelectrodes , Motor Activity/physiology , Reaction Time/physiology , Stereotaxic TechniquesABSTRACT
Dynamics of neuronal interaction in 90 ensembles of the RT including units of two types (A, B) recorded by microelectrodes was analyzed during verbal and sensory stimulation and voluntary motor acts in dyskinetic patients in the course of 38 stereotaxic operations. It was shown that high transient interneuronal cooperation in A and B units were selectively related to triggering stages of a purposive act: verbal commands presentation and movement initiation and realization. Specific character of dynamics of interneuronal cooperation determined both by the type of constituent elements and functionally different stages of voluntary acts was found. It is supposed that transient interneuronal cooperation of A and B units reflects dynamic conjugation of two functionally different cellular subsystems in the Rt which are probably connected with verbal-related processing and triggering as well as with movement-related voluntary acts.
Subject(s)
Cell Communication/physiology , Neurons/physiology , Thalamic Nuclei/physiology , Verbal Behavior/physiology , Acoustic Stimulation , Electromyography , Electrooculography , Evoked Potentials, Auditory/physiology , Humans , Microelectrodes , Motor Activity/physiology , Reaction Time/physiology , Stereotaxic TechniquesABSTRACT
The work is based on the results of operations on the cerebellar dentate nuclei in 92 patients. In 42 of them, combined manipulations were carried out on the cerebellar dentate nuclei and the diencephalic structures (relay nuclei, median centre, pulvinar and subthalamus). Analysis of the results showed that stereotaxic destruction of the ventrooral parts of the cerebellar dentate nucleus is a very effective surgical manipulation in various forms of spastic dyskinesia. A natural decrease in the spastic component of the muscular hypertonia is the principal clinical effect of dentatotomy. Its effect on the rigid component of muscular hypertension is negligible. Combined manipulations on the cerebellar dentate nuclei and diencephalic structures are indicated in cases with combined spastic conditions and hyperkinesia which cannot be corrected by dentatotomy. The analysis of the results of combined interventions on the nuclear structures of the thalamus shows that pulvinarotomy is most effective, it reduces or corrects hyperkinesia in infantile cerebral paralysis and, in addition, causes diminution of the general hypertonia, of the upper extremities before all else. Proper rehabilitation treatment is the decisive factor in the final outcomes of stereotaxic intervention on the cerebellar motor systems and on those of the diencephalon in spastic forms of hyperkinesia.
Subject(s)
Cerebellar Nuclei/surgery , Movement Disorders/therapy , Thalamic Nuclei/surgery , Cerebral Palsy/therapy , Chorea/therapy , Humans , Hyperkinesis/therapy , Muscle Spasticity/therapy , Paralysis/therapy , Stereotaxic TechniquesABSTRACT
In 26 patients with expressed signs of parkinsonism the authors studied the state of higher cortical functions prior to and following stereotaxic operations. The results of such studies point to a distinct connection between the changes of certain mental processes and the side of the operation. It was demonstrated that the subcortical structures of the left and right hemisphere participate in the mnestic function in different ways. The specificity and different directions of postoperative changes in the higher cortical functions may in the opinion of the authors speak in favour of a certain specificity in the contributed organization of mental processes on behalf of the subcortical structures.
