A Clinical and Radiological Correlation of the Lesions Produced by Chemopallidectomy and Thalamectomy

Abstract

The purpose of this paper is to present the clinical and radiological correlation of 360 intracerebral lesions placed in 300 patients who underwent surgery for the treatment of Parkinson's disease. These cases represent a consecutive series of patients, part of a total of more than 800 basal ganglia operations performed on our service since 1952. Details of the surgical technique employed have already been reported (St. Barnabas Symposium on "Surgical Therapy of Extrapyramidal Disorders", 1956;Cooper, 1956;Cooper and Bravo, 1958a).The cases selected for this study have been those operated on by using the balloon cannula technique (Bravo and Cooper, 1957) which allows testing of the physiological effects of a temporary lesion before the injection of alcohol and, by creating a small cavity, facilitates the production of a well-circumscribed alcohol lesion (Cooper and Bravo, 1958b). Such lesions, when the alcohol has been mixed with pantopaque, can be visualized radiographically.In an earlier report we presented the anatomical evidence and the corresponding radiological landmarks obtained as a result of a study carried out in 65 cadaver brains . In that report we studied the anatomical location of 120 intracerebral lesions visualized radiographically and confirmed by anatomical studies of each brain. The conclusions of that paper regarding the radiological and anatomical correlations of certain lesions have been confirmed by other investigators (Amador, personal communication). The results of our anatomical study are also in essential agreement with the data that can be obtained from some of the available brain atlases (Stelmasiak, 1956;Spiegel and Wycis, 1952).The surgical target in the present series of patients was the globus pallidus and/or the thalamus. In our anatomical studies we were also concerned with the radiological projection of these structures and estimation of limits of safety according to shape and size of the skull, size of the ventricles, and relative position of the foramen of Monro and pineal gland. As a result of continuing investigations a series of intracerebral structures have been radiographically outlined (Figs. 1 and 2) and the landmarks for the two surgical targets, namely the mesial globus pallidus and ventrolateral thalamus, were established (Cooper, Bravo, Riklan, Davidson, and Gorek, 1958). The results of the earlier studies can now be related to radiographically visualized lesions in patients.In this paper we are going to consider the radiological location of these lesions in terms of the neurological results which they produced. With the information obtained from the cadaver study it is possible to correlate, with a fair degree of accuracy, the anatomical site of these lesions with the observed effects. However, until definite anatomical proof of the structures involved can be shown, when and if the brains of those patients come to post-mortem examination, we should limit ourselves to an evaluation of the clinical and radiological data. Material and MethodsThree hundred consecut...

The Development of Deep Brain Stimulation for Movement Disorders

“…They also concluded that lesioning the nucleus ventralis intermedius (Vim), was the best treatment for tre mor [159,[185][186][187]. These results were replicated by others [181,187,188]. Also of note is the fact that Hassler et al thought they were operating on the thalamus at times but turned out to have lesioned the STN [184] linking once again the STN to MDs.…”

Stereotactic Targeting of the Ventrointermediate Nucleus of the Thalamus by Direct Visualization with High-Field MRI

“…It includes most of the ventralis oralis anterior, the ventralis oralis posterior and the Vim nuclei as per Hassler's classifi cation [18] . The ventrolateral nuclear mass has been recognized since the early 1950s as the prime surgical target for the relief of tremor [19,20] . Nonetheless, wide variations in the recommended placement of the target have been reported [21] .…”

Electrophysiological Studies in Stereotaxic Surgery for Extrapyramidal Disorders

“…A lth o u g h it is n o t certain th a t th is effect is due to in creased th resh o ld o f em o tio n al stress {W ard [64]) d u rin g these co n d itio n s, it m ay suggest th a t the c en tral in te r actio n p lay s som e role in th e m echanism of the trem o r. On the o th e r h a n d , th e tre m o r w as found to be elim in ated b y lesions o f th e globus pallid us (Spiegel and W ycis an d o thers) or of V L -nucleus of th a la m u s (Iiassler and Riechert [19a], Cooper [4]), w hich disagrees w ith th e h y p o th e sis of th e sp in al origin alone.…”