Electrical Exploration of the Internal Capsule and Neighbouring Structures During Stereotaxic Procedures

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The variability in position, shape and size of deep cerebral structures in relation to radiologically visible landmarks hardly needs to be stressed again and even the most careful plotting of a target point and the most precise instrumentation leave a margin of error which becomes more important as the target is situated farther away from the landmarks used to plot its position.

In an effort to compensate for or minimize this error in localization because of unpredictable anatomical variations, workers in the field of stereotaxic surgery have used various physiological methods to obtain a more precise identification of

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Figures

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    From left to right. Multipolar ring electrode. Curved searching electrode shown with stimulating tip fully extruded. Wire-loop leucotome and straight needle used to deposit small stainless-steel marker at lowermost portion of lesion at end of the procedure. These instruments all penetrate through a single brain puncture.

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    Tracing of anteroposterior and lateral projections of ventriculogram showing estimated area of destruction produced by loop of leucotome when fully extruded in all directions (fine dotted line), paths of searching electrode directed in straight lateral, anterolateral and posterior directions (heavy dots). The electrode can be placed in such a way as to explore electrically structures withing the area of the proposed lesion or immediately beyond it. The small rectangle at the lower border of the outlined lesion is the steel marker placed at the end of the procedure, seen on the postoperative films.

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    Part of horizontal section Hd.+1.5 (plate 55) of the stereotaxic atlas by Schaltenbrand and Bailey9 (rectangle outlined by dotted line in our Fig. 6) on which have been outlined the points stimulated in our Case 21. (Points scattered in horizontal planes +4 mm. to −3 mm. inclusive.) Each square measures 10×10 mm.

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    Diagrammatic representation of location of the corticobulbar and corticospinal fibres in the posterior limb of the internal capsule at the lower border of the thalamus as outlined on horizontal section H.d+1.5 mm. (plate 55) from the stereotaxic atlas by Schaltenbrand and Bailey.9 The horizontal line across the figure corresponds to the midcommissural coronal plane. The rectangle outlined shows the areas represented in our Figs. 4, 5, 7 and 8.

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    Same section as Fig. 4 on which is shown the distribution of points producing motor responses with stimuli of 1 V. or less (coloured dots) and other with no response to stimuli of at least 3 V. (black dots). (Points scattered in horizontal planes +5 mm. to −3 mm. inclusive.)

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    Paths of 16 runs of stimulation (in different patients) along which low-threshold motor responses were obtained. This shows only runs in which it was felt that “motor” portion of the capsule was traversed completely from side to side. (Points scattered in horizontal planes +5 mm. and −4 mm. inclusive.)

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    Distribution of sensory responses obtained at 1 V. or less (same section as Figs. 4, 5 and 8: points scattered between horizontal planes +5 mm. and −2 mm. inclusive).

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