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완전대뇌반구적출 및 척수편절제에 관한 실험적연구

The Effect of Total Cerebral Henmispherectomy and Hemicordotomy in the Dog

최신의학 1970년 13권 12호 p.51 ~ 62
박효일, 이광우,
소속 상세정보
박효일 (  ) - 서울대학교 의과대학 신경외과학교실
이광우 (  ) - 서울대학교 의과대학 신경외과학교실

Abstract


Cerebral hemispherectomy, since its first application by Dandy in 1928, has been a radical procedure performed in patients with infiltrating gliomas of unilateral cerebral hemisphere, and intractable convulsive seizures due to unilateral infantile cerebral atrophy, Sturge-Weber syndrome or diffuse cerebral paragonimjasis.
Among the observed phenomena in those patients the postoperative retention of some of the contralateral motor and sensory functions was coincidental especially in those patients who preoperatively had partial loss of these abilities.
The purpose of this study is to observe the physiological and anatomical findings on the effect of total cerebral hemispherectomy and additional ipsilateral and contralateral upper cervical hemicordotomy in the dog. In this study twelve healthy dogs of both sexes weighing 12 to 17 kg. were subjected to one stage removal of unilateral cerebral hemiphere including the thalamus. In six dogs total cerebral hemispherectomy was performed on the right side and in another six dogs on the left. These experimental animals were clinically observed for periods varying from 40 to 60 days. Then additional upper cervical hemicordotomy was performed on the ipsilateral or contralateral side of total cerebral hemispherectomy and observed the clinical findings four weeks. The brain stem and spinal cord was stained with Swank-Davenport stainning method to observe the degenerated nerve fibers.
The postoperative physiological findings were as follows: In spite of the extensive removal of the unilateral cerebral hemisphere, all of these animals demonstrated early return of consciousness. After recovery from anesthesia, the totally hemispherectomized dogs demonstrated marked flaccid paralysis on the contralateral extremities with good motor function on the ipsilateral side. The contralateral hemiparesis, however, became to recover within a few days and they could get up and walk within a week. Contralateral homonymous hemianopsia, and mild reduction in moor and sensory function on the contralateral side were the only persistent neurological deficity. Following additional ipsilateral or contralateral upper cervical hemicordotomy, all experimental dogs showed complete flaccid hemiplegia on the ipsilateral side. However about two weeks later the hind limb started to regain motor function and four weeks later they could sit up and stand. The consistent neurological deficits were ipsilateral hypotonicity, hypokinesia and dysmetria on the hemicordotomized side without correlation to total cerebral hemispherectomy, but the mild sensory disturbance was persistently observed on the contralateral side of total cerebral bemispherectomy. Upper cervical hemicordotomy was seemed to be not affect the sensory function about one week later.
The anatomical findings were as follows: Microscopic preparations of the animals showed almost complete degenerations in the ipsilateral crus cerebri, pyramidal bundles, .pyramid, decussating fibers, and contralateral lateral corticospinal tract of the total cerebral hemispherctomy and marked ipsilateral lateral corticospinal tract and posterior funiculus on the hemicordotomized side. These degenerated fibers were traced down to the lumbar or sacral level. In the medial longitudinal fascicles and medial lemniscus there
were a few evident degenerated fibers on both sides, but these degenerated fibers were more numberous in the ipsilateral medial longitudinal fascicles and contralateral medial lemniscus.

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