Autonomic and somatomotor responses to electrical stimulation of the posterior hypothalamus are reported in 51 patients with pathologically aggressive behavior. The stimulated area causing rise in blood pressure, tachycardia, and maximal pupillary dilatation lies in the posteromedial hypothalamus, more than 1 mm and less than 5 mm lateral to the lateral wall of the third ventricle, occupying a triangle formed by the midpoint of the intercommissural line, the rostral end of the aqueduct, and the anterior border of the mammillary body. Electrical stimulation of this (ergotropic) triangle resulted in desyncbronization of the electroencephalogram (EEG) with hippocampal theta waves, or diffuse irregular delta waves of high voltage.Cases with violent behavior showed higher plasma levels of non-esterified fatty acids (NEFA) in the fasting stage; these were markedly elevated by electrical stimulation of the ergotropic triangle.Points in the ergotropic triangle where signs of sympathetic discharge were most marked were electrocauterized bilaterally. This procedure produced marked calming effects (95% of the cases) during the follow-up period of more than 2 years. Postoperatively there was a tendency to a decrease in sympathicotonia or an increase in parasympathicotonia. The follow-up plasma level of NEFA was found to have decreased to approximately the normal value.Y. Neurosurg. / Volume 33 / December, 1970 69]
The risk of epileptic seizures after craniotomy is extremely important but the incidence of postoperative epilepsy varies greatly, depending on the patient's conditions such as primary diseases, severity of surgical insult, and pre-existing epilepsy. Animal studies suggest that neurosurgical insults lead to seizures by two different mechanisms: One mechanism is mediated by free radical generation and the other by impaired ion balance across the cell membrane caused by ischemia or hypoxia. Conventional antiepileptic agents such as phenytoin, phenobarbital, carbamazepine, and valproic acid are promising for the prevention of early seizures, but the effect in preventing postoperative epilepsy is still controversial. Studies on the prophylactic effect of newer antiepileptic agents in craniotomized patients were very limited. Zonisamide, an antiepileptic agent with antiepileptogenic, free radical scavenging and neuroprotective actions in experimental animals, showed promising effects against postoperative epilepsy in a randomized double blind controlled trial. Prophylactic treatment for craniotomized patients significantly prevented the development of partial seizures during the follow-up period. Most recent studies have not supported the prophylactic use of antiepileptic agents in craniotomized patients, but further studies are required.
The authors report a new ventriculofiberscope useful in both diagnosing and operating on lesions of the ventricular system. The technique and its advantages are illustrated in representative cases. KeY WoRDs ventriculoflberscope ventriculoscope tumor endoscopic biopsy ventrieulostomy ventricular Address reprint requests to:
A 51-year-old man presenting with radiculopathy a rare cervical dural arteriovenous fistula (AVF) is reported. Angiography revealed that the cervical dural AVF was fed mainly by the left C-3 and C-4 radicular arteries and drained into the internal vertebral venous plexus with no communication with intradural structures. The dural AVF was treated surgically after embolization therapy. Although the AVF showed mass effect on computerized tomography (CT) scanning, abnormal vessels, which were suspected to drain the AVF, were observed intraoperatively to compress the left C-4 and C-5 nerve root sleeves. After resection of these abnormal epidural vessels, monoparesis of the left proximal upper extremity was markedly improved. In this patient, dynamic CT scanning was useful in the initial diagnosis, and the preoperative embolization therapy was very effective.
Spinal and trigeminal dorsal root entry zone destruction (DREZ-tomy) was performed on 35 patients with deafferentation pain of various types. Overall, satisfactory pain relief was obtained in 65.5% of spinal DREZ-tomy cases in the follow-up observation. The result in the brachial plexus avulsion group was the best (82.4% improved), followed by the limb pain group without root avulsion (50.0%), but the truncal or visceral pain group showed the worst result (33.3%). Two patients with postherpetic trigeminal neuralgia were completely relieved of pain in the average follow-up period of 32 months, while in 2 patients with postrhizotomy facial pain, pain recurred 4 months after the operation in 1, and, in the other, pain in the medial part of the face remained unchanged. Complications were seen in about 60% of the patients, which were, however, all mild, except for 2 cases of death due to gastrointestinal disease.
The case is reported of a patient with progressive left hemiparesis due to vascular compression of the medulla oblongata. Metrizamide computerized tomography cisternography revealed that the left vertebral artery was compressing and distorting the left lateral surface of the medulla. Compression was surgically relieved and symptoms improved postoperatively. Neurological and symptomatic considerations are discussed in relation to the topographical anatomy of the lateral corticospinal tract.
The successful surgical treatment of an intrameatal aneurysm is reported, and the signs, symptoms, and neurootological findings discussed. Anatomical consideration of the course of the anterior inferior cerebellar artery and origin of internal auditory artery are emphasized. KEY WORDSintraeranial aneurysm anterior inferior eerebellar artery internal auditory meatus MONG aneurysms of the vertebrobasilar system, an aneurysm of the anterior inferior cerebeUar artery located in the internal auditory canal is very rare. In reviewing the literature, we could find only two surgical cases. 2,4,5 We are reporting a third case. Case ReportA 35-year-old woman was in good health until September 26, 1969, when she suddenly had a severe headache with subsequent nausea and repeated vomiting: after 1 week, the headache gradually improved. On October 22, she experienced a peculiar sensation as if stored water abruptly poured out of her left ear; shortly thereafter the severe headache and repeated vomiting returned. The next morning, she was admitted to a local hospital, where lumbar puncture was performed. The cerebrospinal fluid was bloody and the pressure 270 mm H20. On November 2, facial palsy appeared on the left side, and 2 days later she noticed a left hearing loss and tinnitus. The headache and tinnitus increased in severity, and on No-vember 21 she was transferred to the Tokyo Metropolitan Police Hospital.Examination. Vital signs and general physical examination were normal. The patient was fully alert and oriented, complaining of a continuous headache at the midportion of the left occipital region, which increased on body movement. She complained of a stiff neck but the neck moved normally on testing. Motor and sensory examination was normal; there was no dysdiadochokinesis or hypotonia or signs of pyramidal disease. Handwriting was normal. Although she felt unsteady on standing and walking, the Romberg was absent and gait was normal. Eye movements were normal but there was horizontal nystagmus on right lateral gaze. Pupillary reaction and fundi were normal. The left corneal reflex was diminished, but facial sensation was normal. There was a droop of the left corner of the mouth, and the left eye did not close fully. There was some hearing impairment on the left, and taste was impaired on the anterior two thirds of the left side of the tongue. Other cranial nerves were normal.
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