Campotomy in Various Extrapyramidal Disorders

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In 195029 we observed a 74-year-old patient suffering from hemiballismus that was relieved by a mesencephalic lesion. The patient died 5 weeks postoperatively of bronchopneumonia and renal failure. Macroscopically a lesion was found that extended from the tegmentum of the midbrain lateral to the nucleus ruber into the substantia nigra, as illustrated in Part I of Stereoencephalotomy.28 The histological examination revealed that the lesion produced by us affected the medial part of the substantia nigra and interrupted the mesencephalic part of Forel's field H (Fig. 1). In view of the

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Figures

  • View in gallery

    Lesion (L) of mesencephalic part of Forel's field H and of substantia nigra in a patient relieved from hemiballismus. H = Forel's field; N = substantia nigra on normal side; S=old softening.

  • View in gallery

    Tremor in the left (l.F) and right foreleg (r.F) induced in a cat by stimulation of the left reticular formation. Additional stimulation of left Forel's field (l. Forel) increases the amplitude of the right-sided tremor. (Experiment was described previously32 but not illustrated.)

  • View in gallery

    Fiber systems forming, or passing through, Forel's field H.

    B.c. =

    brachium conjunctivum

    CM =

    centrum medianum

    Co =

    cerebral cortex

    H, H1, H2 =

    Forel's fields

    Hy =

    hypothalamus

    Ma =

    mammillary body

    NcF =

    nucleus campi Foreli

    Pa =

    pallidum

    Pe =

    cerebral peduncle

    R =

    red nucleus

    Re =

    reticular formation

    VL =

    nucleus ventralis lateralis thalami

  • View in gallery

    Fig. 4. Parkinsonism. Photoelectric record of movements of right index finger. (Small bulb attached to finger; its light falls on photocell connected to electroencephalograph). Stylet of electrode is inserted in front of the left red nucleus, between 1 mm. above and 1 mm. below the intercommissural line. D.C, 10 ma flowing from ↑ on to ↓ off. After a latent period of about 2 sec., a tremor develops that first attains a frequency of 9/sec.; then the rate drops to 6/sec. The tremor outlasts the flow of current and eventually has a frequency of 4/sec.

  • View in gallery

    Parkinsonian tremor in right index finger; decrease of its amplitude on stimulation of left Forel's field H (2 msec., pulses, 100/sec. 5 V. on Grass stimulator, 2 V. on the C.R.O., 1 ma as measured by the current probe). The frequency of tremor (4–5/sec.) is not changed. (Its doubling in part of the record is an artifact appearing when movements of the light beam exceeded borders of the photocell.)

  • View in gallery

    Puncture line (P) for production of lesion in Forel's field H in roentgenogram visualizing the Pantopaque-filled 3rd ventricle. Z = zero position of electrode.

  • View in gallery

    Frontal sections showing Forel's field H. Horizontal 0–0 line corresponds to intercommissural line, vertical 0–0 line represents midline. All mm., B 9 mm., C 4 mm. anterior to posterior commissure.

    Ar =

    nucleus arcuatus thalami

    CM =

    centrum medianum

    FH =

    tegmental field of Forel

    H1 =

    fascic. thalamicus

    H2 =

    fascic. lenticularis

    Ni =

    substantia nigra

    Lu =

    corpus luysi

    P =

    cerebral peduncle

    R =

    nucleus ruber

    V3 =

    3rd ventricle

    vpl =

    nucleus ventralis posterolateralis

    Zi =

    zona incerta

  • View in gallery

    Electromyogram of extensors (E) and flexors (F) of left (l) and right (r) forearm in a parkinsonian patient with right-sided tremor. A before, and B after left-sided campotomy.

  • View in gallery

    Myotonogram showing resistance to passive extension (E) and flexion (F) in right elbow of a parkinsonian patient before and after left campotomy.

  • View in gallery

    Myoclonia. Electromyograms of left-sided muscles of neck (1–5) and of left-sided muscles of shoulder (1–3). A before, and B after right-sided campotomy. Intervals between heavier vertical lines correspond to 1sec.

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