SUMMARY Stereotaxic subthalamotomy of 55 patients with cerebral palsy gave a good result in 65 % of the selected cases. The result was uncertain in 15 and poor in 20 %. An independent sociomedical follow-up study confirmed the clinical finding. The more rapid the involuntary movements, the better was the effect of subthalamotomy. When, in the 1940s, more general interest in surgery of the basal ganglia was aroused by the pioneer work of Russell Meyers (1942), it was already known that athetosis could be diminished to some degree by many neurosurgical interventions. The operations could be performed at several levels ranging from the cerebral cortex to the spinal roots. These operations either damaged the efferent motor pathways, causing paralysis, or interrupted some afferent feed-back connections necessary for adequate control of the fine movements.Application of the stereotaxic principle to neurosurgery (Spiegel, Wycis, Marks, and Lee, 1947) raised hopes that a new means had been found to overcome the muscular hypertonia and athetosis of cerebral palsy. The new stereotaxic neurosurgery concentrated on Parkinsonism, the tremor and rigidity of which could be effectively abolished by lesions in the pallidum, pallido-thalamic pathways, ventrolateral thalamus, and subthalamus. It appears likely that in these operations afferent pathways conducting impulses to the premotor and motor cortex were severed and that the beneficial results were due to elimination of disturbances mediated by the feed-back control systems before they reached the pyramidal cells of the motor cortex. Therefore these operations did not produce paresis; on the contrary, they relieved the motor functions from the distressing tremor and rigidity.Naturally, the stereotaxic technique was soon applied to cerebral palsy as well. The results were by no means so good as in Parkinsonism, on account of the difference between the underlying pathological processes. Quite encouraging results were reported, however-for example, by Narabayashi (1962). Some neurosurgeons, on the other hand, were rather disappointed with their results (Yasargil, 1962;Maspes and Pagni, 1965
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