Comparison of 1-year follow-up evaluations of patients with indication for pallidotomy who did not undergo surgery versus patients with Parkinson's disease who did undergo pallidotomy: a case control study.

Unlabelled: Many reports published during the past 5 years have shown evidence of the beneficial effect of posteroventral pallidotomy (PVP) in large groups of patients for up to 3 years, but none of them have compared patients who underwent surgery with a control group.

Objective: To compare the evolution of Parkinson's disease symptoms at 1-year follow-up between patients who underwent surgery and those who did not.

Material And Methods: Ten patients with idiopathic Parkinson's disease refractory to treatment who were included in the Core Assessment for Intracerebral Transplantation program for PVP did not undergo surgery because financial support was lacking.

Unilateral radiofrequency lesion versus electrostimulation of posteroventral pallidum: a prospective randomized comparison.

Microelectrode-guided posteroventral pallidotomy (PVP) has shown to be an effective method in the treatment of a group of patients with advanced Parkinson's disease. A nonlesioning approach by means of deep brain electrodes connected to a programmable neuropacemaker has also been used to inhibit the internal segment of globus pallidus (posteroventral stimulation [PVS]) reporting comparable clinical efficacy to the one obtained with the ablative method. Nevertheless, no controlled studies have been performed to compare the efficacy of both procedures.

Apomorphine induces changes in GPi spontaneous outflow in patients with Parkinson's disease.

Objective: To determine the effect of a single dose of apomorphine on internal globus pallidus (GPi) neuronal discharge in patients with Parkinson's disease (PD).

Patients And Methods: Nine PD patients who underwent microelectrode-guided posteroventral pallidotomy (PVP) were studied. After identification of a single GPi unit discharge with sufficient spike S/N ratio to allow reliable thresholding, basal recording was followed by a single 3-mg subcutaneous injection.

Confirmation of the antidyskinetic effect of posteroventral pallidotomy by means of an intraoperative apomorphine test.

We present a series of six consecutive Parkinson's disease patients undergoing posteroventral pallidotomy (PVP), who received an apomorphine injection after thermolesioning the posteroventral region of the internal globus pallidus (GPi) to evaluate the effect of the lesion on drug-induced dykinesias and therefore to proceed with further lesions or to conclude the surgery. Five of six patients failed to present dykinesias or did so to a significantly lesser degree (F [2,10] 42.6; p < 0.

Involuntary movements during thermolesion predict a better outcome after microelectrode guided posteroventral pallidotomy.

Eight of the first 15 patients with advanced Parkinson's disease who underwent microelectrode guided posteroventral pallidotomy developed transient abnormal involuntary movements during thermolesion, four of whom also did so during high frequency macrostimulation. Abnormal involuntary movements found before thermolesion were choreic, ballistic, or choreoathetoid in nature, usually persisted less than 60 minutes, and were contralateral to the site of thermolesion in six and bilateral in two of them. The appearance of abnormal involuntary movements during macrostimulation or thermolesion of the internal globus pallidus correlated with better surgical outcome as measured by UPDRS motor items and CAPIT timed test, so that they seem to be of prognostic value.

Role of the hypothalamic hamartoma in the genesis of gelastic fits (a video-stereo-EEG study).

Patients having a hypothalamic hamartoma frequently present epileptic attacks of laughter, and they later experience multiple additional seizure types, which invariably lead to a severe drug-resistant epilepsy. If this association is now well-known, relationships between the hypothalamic mass and the different types of seizures remain still mysterious. We report the case of a 16-year-old girl suffering from this peculiar epileptic picture, in whom a stereo-EEG study was performed, allowing us to record both the hamartoma, the neighboring hypothalamic structures, and other bilateral cortical areas.

Stereotactic approach to intracranial lesions.

The diagnostic and therapeutic approach to intracranial lesions must be different considering the different possibilities offered by the various methods. The diagnostic reliability and safety of stereotactic biopsy are often indispensable in order to optimize the subsequent therapy. The results obtained in selected pathologies allow us to propose the stereotactic approach to treat: -various kind of cysts by aspiration and/or Beta endocavitary radiation therapy; -blood or abscessual collections that can be aspirated in a similar way; -arterio venous malformations or tumours by radiosurgery; -tumours by brachicurietherapy or by computer assisted stereotactic surgery.

[Radiosurgical treatment of minor intracranial arteriovenous malformations by using a linear accelerator].

This study deals with 43 patients with cerebral arteriovenous malformations (AVMs) of a maximum of 20 mm in diameter. All of them were radiosurgically treated with a linear accelerator in stereotatic conditions (UMIC). The delivered doses vary from 20 gys to 50 gys.

Radiosurgery with a linear accelerator. Methodological aspects.

Based on the concepts of Leksell and on recommendations of different Swedish physicists on the use of linear accelerator for radiosurgical use, we developed a new methodology coupling the Talairach stereotactic system with a commercial linac. Anatomical facts encouraged us to use coronal angles of irradiation employing the angular displacement of the linac above the horizontal plane. Different coronal planes are obtained by rotation of the stereotactic frame.

Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations.

An original stereotactic radiosurgical approach coupling a) Talairach's stereotactic methodology, b) a specially devised mechanical system, and c) a linear accelerator is detailed. The authors present their preliminary results on 66 patients with nonsurgical intracranial arteriovenous malformations. The doses delivered for treatment varied from 20 to 70 Gy.

Differential diagnosis between tumoural and non-tumoural intracranial lesions in children: a stereotactic approach.

The rational management of intracranial lesions should be based on the exact definition of the nature of the lesions and, when it is possible, on their spatial definition. Since External Radiotherapy (ERT) and cytostatic therapy are not free of undue effects, especially in children, such treatments should be used only when a "sure" diagnosis is obtained. The aim of this paper is to study the results allowed by the Talairach's stereotactic methodology in children.

[Stereotaxic diagnosis and treatment of colloid cysts of the 3d ventricle. Apropos of 7 cases].

The clinical and anatomical results of the treatment of 7 colloid cysts of third ventricle by stereotaxic aspiration are reported. A history of increased intracranial pressure was reported in all patients (4 females aged of 12, 16, 28, 38 years; 3 males aged of 36, 54, 59 years). A ventricular shunting device has been inserted in 4 patients.

[Complementarity of x-ray computed tomography of staged stereotaxic biopsies and of stereo-electroencephalography in the spatial definition of intracranial lesions].

This study concerns 180 patients (132 M; 48 F) (age: 2 to 69 years; m: 33 years) who underwent stereotactic procedures according to the methodology of Talairach and Szikla. Such procedures (stereotactic and stereoscopic angiography in all cases, and ventriculography in 81%) should permit a correct spatial definition of intracranial lesions. The informations provided by the angiography (normal in 7%) and by the ventriculography (normal in 11%) are complementary to those yielded by the TDM and permit an easier and safe stereotactic approach to the lesions.

[Value and technic of translating the data from x-ray computed tomography into the stereotaxic coordinates of the Talairach system].

The neuroradiological stereotactic examinations provide indispensable information to localize many intracranial lesions: the data obtained by the CT-Scan are complementary of the stereotactic ones. The transfer of the routine CT-Scan transverse axial slices into the Talairach stereotactic system needs a precise definition of the inclination of the plan of the slices and a correct evaluation of the mean magnification factor. The inclination of the slices is appreciated using the bony, vascular and ventricular landmarks clearly identified on the CT-Scan and stereoscopic stereotactic images.

Stereotactic aspiration of colloid cysts of the third ventricle. Preliminary report.

From January, 1979, to July, 1986, 10 patients (6 females, 4 males; 12-59 years, mean 37) with colloid cysts of the third ventricle were treated by stereotactic aspiration (Talairach's method). Five cysts have been completely aspirated. The mean residual volume of the other 5 was 19% of the initial volume.

[Stereotaxic treatment of expanding cysts in craniopharyngiomas by endocavitary beta-irradiation (Re-186; Au-198; Y-90)].

The authors report the results of 17 intracystic injection of colloidal 186 rhenium, 2 colloidal 198 gold, and 1 colloidal 90 yttrium for endocavitary treatment of 18 cystic craniopharyngiomas (16 pts during a period ranging from January 1975 till July 1982. Follow-up studies ranging from 12 to 72 months (m: 36 m) revealed that all craniopharyngiomas cysts were effectively treated with cessation of fluid formation, progressive shrinkage of the formerly expansive cysts, and finally cyst obliteration in 75% of the cases. No early or late side-effects were observed during the entire observation period.

[Multiple-beam stereotaxic irradiation].

The "Talairach" stereotactic multibeam irradiation system developed by the authors allows to irradiate selectively small intracranial or intraorbital lesions localized in the Talairach stereotactic system. The centre of the target volume is placed in the isocentre of rotation of a linear accelerator (160 degrees), a special head fixation allows for a stepwise rotation of the head (145 degrees) around the centre of the lesion. Special collimators adapt the width of the high energy photon beam to the dimensions of the target (some millimeters to 3 cm), creating a high dose radiation field limited to the lesion (deep AVM, pituitary adenomas, small gliomas in critical areas etc.

[Current experience of stereotaxic irradiations in the treatment of hemispheric gliomas (author's transl)].

Authors present a short review of the techniques and results of the stereotactic focal irradiations (S.I.) used at present in France for the treatment of small "active" gliomas localized in high risk areas (functional and vital) of the brain.

Circadian patterns of growth hormone, prolactin and corticotrophin secretion in hypothalamic and extra-hypothalamic lesions localized by stereotactic neuro-radiology in humans.

The integrity of mediobasal hypothalamus for the maintenance of normal circadian rhythms has been clearly established in the animal. Using precise stereotactic neuroradiologic localisations of various brain tumors, the authors demonstrate that in human, cortical lesions induce no significant modifications of the circadian variation of GH, prolactin or ACTH. In contrast subcortical lesions displacing the 3rd ventricle result in an inhibiton of the nocturnal rise in GH and prolactin, whereas the circadian rhythm of ACTH remains normal.

Stereotactic hypothalamotomy for behaviour disorders.

Posterior hypothalamotomy is a relatively simple stereotactic procedure. The radiological determination of the target and its physiological corroboration by electrical stimulation are accurate. The lesions have always been made in the site of maximum sympathetic response.