Stereotaxis in Parkinson Syndrome: Clinical-Anatomical Contributions to Its Pathophysiology by R. HasslerStereotaxis in Parkinson Syndrome: Clinical-Anatomical Contributions to Its Pathophysiology by R. Hassler

Stereotaxis in Parkinson Syndrome: Clinical-Anatomical Contributions to Its Pathophysiology

byR. Hassler, F. MundingerForeword byE.A. Spiegel

Paperback | June 29, 2012

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Despite the amazing progress made by the stereotactic technique, particularly regarding the localization of the target, despite the extreme caution, which stereotactic neurosurgeons apply at every step of the procedures, despite the routine roentgenologic and physiologic controls (depth EEG, electric stimulation) preceding the production of a lesion, there remains a certain degree of uncertainty regarding the position, shape and extent of the lesion as well as of the electrode track and also regarding unintended lesions in the vicinity. The final answer to these questions depends on the anatomical control. Thus we must be grateful to the authors, who performed 3700 subcortical stereotactic interventions, that they present a careful comparison of the clinical and of the pathologic­ anatomic findings, in the cases whose brains could be studied. They demonstrate what degree of exactness can be expected from the stereotactic technique. They also present a careful outline of the morphology, physiology, biochemistry and pathology of the structures that are affected in Parkinson patients. In addition this monograph permits one to familiarize oneself with the methods of stimulation and destruction practiced by the authors. The relevant literature is conscientiously quoted. A study of this mono­ graph will benefit not only the stereotactic neurosurgeon, but also neurophysiologists, pathologists and practicing neurologists.
Title:Stereotaxis in Parkinson Syndrome: Clinical-Anatomical Contributions to Its PathophysiologyFormat:PaperbackDimensions:320 pagesPublished:June 29, 2012Publisher:Springer NatureLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:3642665233

ISBN - 13:9783642665233

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Table of Contents

I. Introduction.- II. Basis of the Parkinson Syndrome: Morphology, Physiology, Biochemistry, and Pathology.- 1. Afferent Inputs of the Extrapyramidal Motor Nuclei.- 1.1. Putamen and Cauda tum ( = Striatum).- 1.2. Pallidum.- 1.3. Nucleus Subthalamicus.- 1.4. Nucleus Ruber.- 1.5. Substantia Nigra.- 2. Connections Within the Extrapyramidal System and the Functional Significance of Individual Nuclei.- 2.1. Putamen and Cauda tum ( = Striatum).- 2.2. Pallidum.- 2.3. Nucleus Ruber.- 2.4. Substantia Nigra.- 2.4.1. Synapses of the Striato-Nigral Circuit and Their Transmitters.- 2.4.2. Mode of Action of the Anticholinergic Drugs Against Parkinson Symptoms.- 2.4.3. Efferent Pathways of the Substantia Nigra.- 2.4.4. Neuropathology of the Substantia Nigra.- 2.4.5. Anatomical Differential Diagnosis of the Parkinson Syndrome.- 2.4.6. Localization of the Various Signs in Parkinsonism.- 2.4.7. Experimental Lesions in Substantia Nigra.- 2.4.8. Stimulation of the Substantia Nigra.- 2.5. Other Neuronal Systems Linked to the Extrapyramidal System.- 2.5.1. Nucleus Lateropolaris (L.po or VA).- 2.5.2. Nucleus Ventro-oralis anterior (V.o.a) or Anterior Part of the Ventral Half of the Nucleus Ventralis Lateralis (VL).- 2.5.3. Nucleus Ventro-oralis posterior (V.o.p) or Caudal Part of the Ventral Half of VL.- 2.5.4. Nucleus Ventrointermedius (V.im.- 2.5.5. Nucleus Ventrocaudalis (V.c.e= VPL and V.c.i= VPM).- III. Clinical and Pathophysiologic Findings Related to Autopsy Data in Cases of Parkinsonism Operated on by Stereotaxis.- 1. Methods.- 2. Case Histories.- IV. Correlations.- 1. Remarks on the Accuracy of Reaching the Target.- 2. Comparative, Radiologic, and Anatomical Evaluation of the Cerebral Reference Lines.- 2.1. Sagittal Reference Line or Baseline.- 2.2. Vertical Reference Line.- 2.3. Reference Line in the Frontal Plane.- 3. Anatomical Accuracy of Our Stereotaxic Procedure for Reaching the Target.- 3.1. Discussion of Accuracy.- 4. Correlation of the Effects of Stimulation During the Operation with the Anatomical Substrates.- 4.1. Method of Stimulation.- 4.2. Increasing the Tremor.- 4.3. Blocking of Tremor.- 4.4. Slowing of Rhythm of Tremor.- 4.5. Acceleration of Tremor.- 4.6. Jerks at Rate of Stimulation.- 4.7. Change in Speed of Movement.- 4.8. Change in Counting.- 4.9. Ocular Effects.- 4.10. Vegetative Effects.- 4.11. Psychological Effect of Stimulation.- 5. Correlation of the Electrophysiologic Findings with the Anatomical Substrates.- 6. Correlation of Coagulations of the Anatomical Structures with Functional and Therapeutic Effectiveness.- 6.1. Physical Parameters and Size of Coagulated Area.- 6.1.1. Methods ofInactivation.- 6.1.2. Used Methods of High-Frequency Coagulation.- 6.1.3. Anatomical Determination of the Size of Coagulation and the Consequent Alterations.- 6.2. Correlation of Parkinson Symptoms with the Coagulated Structures.- 6.3. Correlation of Rigidity.- 6.3.1. Thalamotomy.- 6.3.2. Significance of the Pallidothalamic Systems for the Production of Rigidity.- 6.4. Correlation of Tremor.- 6.4.1. Thalamotomy.- 6.4.2. Pallidotomy.- 6.4.3. Influence of Different Parts of the Internal Capsule on the Effect on the Tremor.- 6.4.4. Significance of the Dentato-thalamocortical System for Mechanism of Tremor.- 6.5. Correlation of Akinesia, Neglect, and Festination.- 6.5.1. Discussion of the Concept of Akinesia and Hypokinetic Signs.- 6.5.2. Correlations of Hypokinetic Signs.- 6.5.3. Relevance of Extrapyramidal Systems to Akinesia and Hypokinetic Signs.- 6.6. Correlation of the Vegetative Symptoms with Inactivated Structures.- 6.7. Correlation of Side Effects with the Damaged Structures.- 6.7.1. Reduction of Expressive Facial Movements.- 6.7.2. Voluntary Weakness of the Facial Nerve.- 6.7.3. Reduction of the Postural Tone of the Arm.- 6.7.4. Deviation During Walking.- 6.7.5. Hemiparesis.- 6.7.6. Dysphagia.- 6.7.7. Aphonia.- 6.7.8. Dysarthria.- 6.7.9. Postoperative Binocular Deviation.- 6.7.10. Ballistic Hyperkinesia.- 6.7.11. Myoclonic Hyperkinesia.- 6.8. Correlation of Postoperative Psychological Disorders with the Damaged Structures.- 6.8.1. Disorders ofInitiative.- 6.8.2. Experience of the Double (Doppelganger).- 6.8.3. Negativism with Mutism or Vigil Coma.- 6.8.4. Confusional Syndrome.- 6.8.5. Impairment of Consciousness.- V. Findings Regarding the Functional Anatomy of Individual Diencephalic Systems.- 1. Lesions in Forel's Bundle HI (Fasciculus Pallido-thalamicus).- 2. Change of Speed of Movement and Laughing Caused by Localized Stimulation.- 3. Loquaciousness.- 4. Functional Organization of the Internal Capsule Corresponding to the Neighboring Ventral Nuclei of the Thalamus.- 5. Dependence of the Improvement of Tremor on Additional Coagulation of the Nucleus Lateropolaris and Neighboring Parts of the Internal Capsule.- 6. Contribution to the Problem of Efferent Connections of the Substantia Nigra.- 7. Impairment of Consciousness Due to Bilateral Lesions in Nonspecific Nuclei of the Thalamus or in the Pallidothalamic System.- VI. Conclusions.- 1. Determination of the Target Point in the Individual Patient.- 2. High-Frequency Coagulations.- 3. Check by Stimulation.- 4. Further Checks on the Accuracy with which the Target Structure is Reached.- 5. Special Indications for Therapeutic Results.- 5.1. Rigidity of Parkinsonism.- 5.2. Akinesia and Hypokinesia.- 5.3. Tremor at Rest.- 6. Pathophysiology of Parkinson Syndrome.- 6.1. Tentative Interpretations of Parkinson Symptoms: a) Disorders of Nigrostriatal Circuit Function and b) Antagonism of Descending Nigral and Pyramidal Impulses in Anterior Horn Apparatus.- 6.2. Tremor.- 6.3. Rigidity.- 6.4. Akinesia and Festination.- 6.5. Vegetative Symptoms.- 6.6. Bradyphrenia.- 6.7. Pathomorphologic Differential Diagnosis of the Different Etiologic Forms of Parkinsonism.- 6.8. Are the Described Cases Representative?.- 6.9. The Future of Therapy in Parkinsonism.- Atlas of the Basal Ganglia in Parkinsonism.- 1. Architectonic Differentiation and Methods of Staining.- 2. Arrangement of the Planes of Section.- 3. Introduction to the Determination of Individual Target Points.- 4. Description of the Series of Frontal Sections.- 5. Description of Serial Sagittal Sections.- References.