The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part I. Surgical Technique for Tailoring Individualized Stereotactic Lesions

Abstract

During the 1950s through the 1970s, Hans Orthner and Fritz Roeder, two German neurologists from Göttingen, developed a sophisticated technique to perform functional stereotactic surgery with outstanding accuracy. They introduced direct air ventriculography performed in the same surgical session as the ablative stereotactic procedure. For individualized surgical targeting, Orthner prepared a stereotactic atlas (>60 brains) with an ingenious brain-slicing device, the Göttinger macrotome. Brains were grouped based on similarity of six different head and ventricle measurements. A brain cluster representing the best match for a patient was selected for stereotactic targeting. Stereotactic lesions were tailored in an individual manner and shaped by stringing together multiple small coagulations following intraoperative test stimulation. This was achieved from a single probe trajectory by using well-engineered string electrodes with calibrated curving and involved laborious calculations. Only high-frequency thermocoagulation was regarded as appropriate for lesioning. With this meticulous technique, the most advanced stereotactic procedures were performed, including bilateral pallidotomy that ultimately could be restricted to the ansa lenticularis and ventromedial hypothalamotomy, the most delicate stereotactic operation performed to date. Outside Göttingen, this technique has only been used by Prof. Dieter Müller in Hamburg, Germany. This elaborate stereotactic approach is widely unknown and deserves to be discussed in a historical context.

Pallidotomy in Parkinsonian Disease: The Renaissance

“…while in our study patients were usually aged and no cause of exposure was found, mostly it was idiopathic while in other Almost all patients had improvement intheir symptoms and a decrease in medication dose, some with minimal to moderate complication. The pallidotomy significantly improves the symptoms and improved the daily life activities of the patient as it is seen in many studies that pallidotomy has markedly modified symptoms of Parkinson's disease like dyskinesia, rigidity and tremor [12,13,14] .From the experience through multiple studies, it is gained that bilateral pallidotomy can have negative impact like swallowing, speech and cognition defect which can lead to depression [15] .Therefore, we performed all our cases unilaterally, to get over such complications. Keep close observation, studies have shown that overall, 25 % to 35% percent reduction is seen in UPDRS III motor score in the duration of 6 months clinical follow-up [13] .…”

The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part II: Long-Term Outcome and Postmortem Analysis of Bilateral Pallidotomy in the Pre-Levodopa Era

“…The unique stereotactic approach of the Göttingen group based on head and brain (ventriculographic) measurements and Orthner’s stereotactic atlas has been reviewed in detail [23]. After lessons had been learned from, for example, staged pallidal lesioning for hemiballism [24] (Fig.…”

“…They regarded the pallidum as “structurally intact and healthy,” but “hyperactive” and “disinhibited” (authors’ translation), and, by reasoning in terms of pathological projection systems, they attempted to interrupt its outflow [15]. Stimulation and lesioning were made exclusively with string electrodes, although rod (straight needle) electrodes had already become more popular at that time [23] (online suppl. material String Electrodes).…”