Percutaneous cordotomy and cerebral evoked response [proceedings].
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Biomedical subjects
Publications and source records attributed to H Kawabatake.
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Rostral mesencephalic reticulotomy (RMR) has been performed since 1973 for relief of intractable pain. The target area is in the midbrain reticular formation (MRF) bordering the periaqueductal gray matter at the superior collicular level. The target of RMR is 13--16 mm posterior to the midpoint of the AC-PC line and 5--8 mm below the AC-PC line. The laterality of the target is measured from the center of the aqueduct, ranging 5 to 8 mm from the midline. The rationale for this procedure is based upon the previous findings that the brain stem reticular formation plays a more important role above the spinal cord level than the lateral spinothalamic tract in the central conduction of nociceptive impulse. In the present study, intraoperative single neuron recording was made with tungsten microelectrodes from the human midbrain tegmentum in response to peripheral pinprick stimulation. These nociceptive neurons were classified into three groups in regard to the unit latency from the peripheral pinprick stimulation.
There have been a few reports about intracranial giant aneurysms treated by intracranial direct approaches. Especially, for giant aneurysms of the internal carotid artery, direct operation has been thought to be difficult to perform because of the anatomical particularity and the danger of rupture during surgery. So the cervical carotid ligation has frequently been indicated. However, the carotid ligation does not relieve the symptoms caused by the giant aneurysm as an "intracranial mass lesion". The authors have reported here, a cured case of a giant aneurysm of the intracavernous portion of the internal carotid artery, to which, as the first step, ligation of the internal carotid artery in the cervical region was performed, and as the second step, endaneurysmorrhaphy was carried out for the remaining symptoms caused by the "intracranial mass lesion". Furthermore, the surgical techniques for treatment of giant aneurysms of the internal carotid artery were discussed citing literatures, and the authors concluded that the combined operation of carotid ligation and endane-urysmorrhaphy could be effective to giant aneurysms in this region. Meanwhile, a new concept concerning the anatomy of the carotid-cavernous region already proposed by Bedford, was confirmed by our observation at operation. It may be considered that the intracranial direct approach to aneurysms in this region and also to carotid cavernous fistulae should more frequently be indicated than ever performed, according to the new concept of the anatomy in this region.
67 cases of various functional disorders of the diencephalon were examined by EMI scanner. The patients were composed of 38 cases of parkinsonism, 7 cases of thalamic syndrome, 6 cases of choreoathetoid movement, 2 cases of dystonia, 11 cases of involuntary movement of unknown etiology and 1 case of torticollis, tic, and ballismus, respectively. In parkinsonism, 79% showed diffuse cerebral atrophy, 5% had focal low density in the substantia nigra and the thalamus, whereas 16% remained normal. Pre- and postoperative assessment with CT scan was briefly discussed with reference to stereotactic surgery of the diencephalon.