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筋緊張 및 運動障害와 새로운 立體定位的深部腦手術法에 대한 硏究

A New Method of Stereotactic Encephalotomy for Dystonias and Dyskinesias

최신의학 1960년 3권 1호 p.69 ~ 78
이철우,
소속 상세정보
이철우 (  ) - 수도의과대학병원 신경외과

Abstract


A development of the operations for extrapyramidal disorders has been known as one of the newest progress in neurological surgery. Pallidectomy and thalamectomy above all have become parti,ularly of importance in the field of physiological neurosurgery. A destructive lesion directly made into the medial nucleus of the globus pallidus whether by means of chemical injection or electrical coagulation cures many tunes the dystonias and dyskinesias such as parkinsonism, dystonia musculorum deformans, chorea, athetosis, hemiballismus and spastic cerebral palsy etc.. .
Since James Parkinson described brilliantly and in full detail the syndrome bearing his name in 1817, there has neither been a satisfactory idea of the nature of Parkinsonism nor a cogent way of dealing with it until about 1952 when the extrapyramidal
surgery became to develop. By this time many surgeons have attempted cortico-spinal tractotomy in various levels in order to relieve the tremors and rigidities, but the most of their operations have substituted a degree of hemiplegia or hemiparesis. As for extrapyramidal surgery, Meyers has already started doing pallido-fugal section for Parkinsonism without remaining hemiplegia in 1942, and subsequently Fenelon, Narabayashi, Guiot and Brion, Spiegel and Wycis, and Cooper have developed the various types of operation. The target, through their experiences, has limited to medial nucleus of the globus pallidus. By 1958 Cooper has operated more than 650 Parkinson´s cases with 75%80% improvement. At present time as Cooper stated, nucleus ventralis lateralis of the thalamus became to be an another important target for dyskinesias tChemothalamectomy).
Many types of stereotactic apparatus have been reported since 1947, but most of them are more or less inaccurate as far as radio-stereotactic measurements are concerned. Difficulties in localizing the tip of the needle have always annoyed surgeons in performance of pallidectomy or thalamectomy. The tip of the needle must be placed accurately into the brain where the desired subcortical structure

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