Full Description
Despite the amazing progress made by the stereotactic technique, particularly regarding the localization of the target, despite the extreme caution, which stereotactic neurosurgeons apply at every step of the procedures, despite the routine roentgenologic and physiologic controls (depth EEG, electric stimulation) preceding the production of a lesion, there remains a certain degree of uncertainty regarding the position, shape and extent of the lesion as well as of the electrode track and also regarding unintended lesions in the vicinity. The final answer to these questions depends on the anatomical control. Thus we must be grateful to the authors, who performed 3700 subcortical stereotactic interventions, that they present a careful comparison of the clinical and of the pathologic anatomic findings, in the cases whose brains could be studied. They demonstrate what degree of exactness can be expected from the stereotactic technique. They also present a careful outline of the morphology, physiology, biochemistry and pathology of the structures that are affected in Parkinson patients. In addition this monograph permits one to familiarize oneself with the methods of stimulation and destruction practiced by the authors. The relevant literature is conscientiously quoted. A study of this mono graph will benefit not only the stereotactic neurosurgeon, but also neurophysiologists, pathologists and practicing neurologists.
Contents
I. Introduction.- II. Basis of the Parkinson Syndrome: Morphology, Physiology, Biochemistry, and Pathology.- 1. Afferent Inputs of the Extrapyramidal Motor Nuclei.- 2. Connections Within the Extrapyramidal System and the Functional Significance of Individual Nuclei.- III. Clinical and Pathophysiologic Findings Related to Autopsy Data in Cases of Parkinsonism Operated on by Stereotaxis.- 1. Methods.- 2. Case Histories.- IV. Correlations.- 1. Remarks on the Accuracy of Reaching the Target.- 2. Comparative, Radiologic, and Anatomical Evaluation of the Cerebral Reference Lines.- 3. Anatomical Accuracy of Our Stereotaxic Procedure for Reaching the Target.- 4. Correlation of the Effects of Stimulation During the Operation with the Anatomical Substrates.- 5. Correlation of the Electrophysiologic Findings with the Anatomical Substrates.- 6. Correlation of Coagulations of the Anatomical Structures with Functional and Therapeutic Effectiveness.- V. Findings Regarding the Functional Anatomy of Individual Diencephalic Systems.- 1. Lesions in Forel's Bundle HI (Fasciculus Pallido-thalamicus).- 2. Change of Speed of Movement and Laughing Caused by Localized Stimulation.- 3. Loquaciousness.- 4. Functional Organization of the Internal Capsule Corresponding to the Neighboring Ventral Nuclei of the Thalamus.- 5. Dependence of the Improvement of Tremor on Additional Coagulation of the Nucleus Lateropolaris and Neighboring Parts of the Internal Capsule.- 6. Contribution to the Problem of Efferent Connections of the Substantia Nigra.- 7. Impairment of Consciousness Due to Bilateral Lesions in Nonspecific Nuclei of the Thalamus or in the Pallidothalamic System.- VI. Conclusions.- 1. Determination of the Target Point in the Individual Patient.- 2. High-Frequency Coagulations.- 3. Check byStimulation.- 4. Further Checks on the Accuracy with which the Target Structure is Reached.- 5. Special Indications for Therapeutic Results.- 6. Pathophysiology of Parkinson Syndrome.- Atlas of the Basal Ganglia in Parkinsonism.- 1. Architectonic Differentiation and Methods of Staining.- 2. Arrangement of the Planes of Section.- 3. Introduction to the Determination of Individual Target Points.- 4. Description of the Series of Frontal Sections.- 5. Description of Serial Sagittal Sections.- References.
