By H. Narabayashi M.D. (auth.), F. John Gillingham, Edward R. Hitchcock (eds.)
Read or Download Advances in Stereotactic and Functional Neurosurgery 2: Proceedings of the 2nd Meeting of the European Society for Stereotactic and Functional Neurosurgery, Madrid 1975 PDF
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Additional info for Advances in Stereotactic and Functional Neurosurgery 2: Proceedings of the 2nd Meeting of the European Society for Stereotactic and Functional Neurosurgery, Madrid 1975
Stereotactic anatomy of the dentate nucleus is still controversial. As a target, we chose a point 10 mm behind the line tangent to the floor of the IVth ventricle, 5 mm below the line perpendicular to the floor of the IVth ventricle passing through the apex of this structure and 14 mm laterally to the midline. A directional burr hole (stereo- 10 20 30 40 50 60 Fig. 1. Age of the 50 patients at the time of the operation tactically) is made with a dental drill of 2 mm diameter and the electrode introduced at an appropriate angle to penetrate the dentate nucleus in the frontal and sagittal main axis.
As retrocollis and axial deformity did not appear to respond at all to ablation of this nucleus. I believe that thalamotomy is the initial procedure for most cases of dystonia musculorum deformans and that dentatectomy should be reserved as an adjunct for severe painful limb and axial posturing as a last resort. I do not believe that our results warrant further use of this procedure in patients with advanced cerebral palsy. Although it is true that motor performance can be altered to the initial enthusiasm of the family and nursing personnel, it is also clear that an objective verification of useful gains or reduced problems in management could not be made.
In only 2 of 5 patients affected by choreoathetosis was it observed that a significant improvement of symptomatology occurred and this concerned especially the athetoid component. In infantile spastic hemiplegia, useful results were observed in 5 of 7 patients operated on. In particular, favourable results were obtained in three patients operated on bilaterally. In infantile spastic diplegia we observed favourable results in Neurosurgical Treatment of Spasticity and Dyskinesias 29 7 patients who showed spasticity of a mode rate degree, while in 4 other patients suffering from serious spasticity the results were not satisfactory.