Applied neurophysiology最新文献

The location and extent of thalamic lesions following thalamotomy can be identified as a large low density area in the acute stage to a small spot in the chronic stage. Stereotactic experimental radiofrequency lesions were placed in the thalamus of 35 mongrel dogs. CT images and whole brain specimens were obtained on days 0, 3, 7, 10, 14, 21 and 60. The appropriate time to map the lesions in the thalamus was thought to be about day 14, because of the thalamic size ratio and the correction of the ventricular deformity. The histological area of the lesion at day 14 corresponded better to the contrast-enhanced area than to that of the plain CT. These results suggest that the lesion demonstrated by contrast-enhanced CT scans at day 14 gives the best anatomical mapping of the actual histological defect.

Microelectrode recording and microstimulation (in 1 case macrostimulation) were used to localize stereotactic targets in 8 patients with central and deafferentation pain and 1 'deafferented control' patient without pain. Off-line study revealed two features commonly proposed as potential physiological factors for such pain, but they were present in both pain and control patients--somatotopographic reorganization and the presence of bursting cells. In all patients in whom stimulation induced pain referred to deafferented parts of the contralateral body, hyperpathia or allodynia were present instead of normal paraesthetic, sensorimotor or thermal responses.

A 0.5-mm step atlas was interpolated from Schaltenbrand-Bailey's atlas. By serial display of the atlas with the desired rotation on a three-dimensional axis, a three-dimensional atlas was created. The newly created atlas can be used for computer-processed stereotactic data display. Any three-dimensionally located point can be displayed within 0.25 mm distance from the point, and spatial understanding of anatomical structures and stereotactic data is facilitated by the three-dimensional display.

Of 67 patients with cerebral tumours studied by MRI, 60 underwent stereotactic biopsy for histological diagnosis. The data from MRI were compared with those obtained from the CT scan with regard to the pathological diagnosis. The tumoural nature and extent of a lesion were better revealed by MRI. The single or multiple localization of the process was also seen better by MRI. Moreover, the sagittal-plane views shown by MRI provide much more accurate target placement and probe guiding for an orthogonal stereotactic approach. Finally, a post-biopsy MRI can show the biopsy site in relation to the tumour better.

A 69-year-old man developed abdominal pain, fever, shaking chills and acute hemiplegia. Computed tomography (CT) scanning demonstrated a hematoma within a thalamic space-occupying lesion having the radiological characteristics of a malignant glioma. Low-grade fever and leukocytosis persisted and follow-up CT scanning showed ring enhancement of the thalamic lesion and ependymitis suggesting a cerebral abscess. Stereotactic aspiration achieved drainage of the abscess and relief of mass effect and provided pus from which a causative organism was identified and treated with appropriate antibiotics. Contrast-enhanced CT scan should be obtained in cases of hemorrhage within mass lesions and tissue diagnosis should be achieved even in deep brain regions, as this can be accomplished safely using stereotactic techniques.

Brainstem-scalp discharge propagation was evaluated in 20 patients with chronic pain, of which 10 were ranked according to the frequency of involved systems making up the chronic pain syndrome. It is concluded that brainstem discharges alone were sufficient to generate the chronic pain syndrome.

A stereotactic atlas to determine thalamic target sites has been incorporated into a microcomputer. Variability studies of the thalamus with mean and standard deviations of nuclear borders are depicted graphically for overlay onto operative images. Internal landmarks traditionally used to reference target points for functional stereotaxis may be determined by conventional ventriculography or derived from magnetic resonance scans. Modeling of polyline vertices established from gray scale contour mapping and atlas reconstructions further enhance the spatial understanding of relationships to midline structures. Computer integration of anatomic reference points, graphically depicted images and stereotactic atlas data into head frame coordinates can be accomplished. This method is consistent with established stereotactic techniques and allows the visual conceptualization of imaged and graphic data for functional stereotaxis.

Magnetic Resonance Imaging (MRI) offers a non-invasive method to visualize the intracerebral structures. Coupled to a compatible stereotactic frame and software, MRI can be used to determine the coordinates of intracranial targets. Coordinates of the anterior commissure, posterior commissure, targets and intercommissural distance were obtained from positive contrast ventriculography and by MRI in 6 patients undergoing stereotactic localization prior to the implantation of stimulating thalamic electrodes for pain control. The correlation of coordinates and measurements obtained with ventriculography and MRI is +/- 1 mm in most measurements, but up to 3 mm in 2 cases. Magnetic resonance stereotaxy allows non-invasive and precise localization of intracerebral targets, but does not yet allow its routine use with confidence. Further understanding of distortion and artifacts and corrections of these is mandatory.