Stereotaxic surgery for cerebral palsy

1974 ◽  
Vol 40 (5) ◽  
pp. 577-582 ◽  
Author(s):  
V. Balasubramaniam ◽  
T. S. Kanaka ◽  
P. B. Ramanujam
Keyword(s):  
Cerebral Palsy ◽  
Content Type ◽  
Involuntary Movements ◽  
Stereotaxic Surgery ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ An analysis of 94 cases of cerebral palsy treated by stereotaxic surgery is reported. The selection of patients and target areas for surgery are discussed. Hypertonic cases are classified into rigid, rigidospastic, and spastic types on the basis of surface electromyographic studies. For rigidity and rigidospasticity, ventrolateral thalamotomy gives relief, while spastic cases do well with dentatectomy. Centromedian thalamotomy relieves sensory-induced involuntary movements. Involuntary movements unaccompanied by changes in tone are abolished by lesions of the nucleus ventralis intermedius.

Surgical treatment of spontaneous intracerebral hemorrhage

1973 ◽  
Vol 39 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Jean E. Paillas ◽  
Bernard Alliez
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Cerebral Hemorrhage ◽  
Preoperative Diagnosis ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.

Radical one-stage correction of craniofacial anomalies

1975 ◽  
Vol 42 (5) ◽  
pp. 522-529 ◽  
Author(s):  
Fred J. Epstein ◽  
Donald Wood-Smith ◽  
John M. Converse ◽  
M. Vallo Benjamin ◽  
Melvin H. Becker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Craniofacial Anomalies ◽  
Content Type ◽  
One Stage ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ The authors present their experience in the surgical treatment of 66 patients with craniofacial anomalies, and discuss selection of patients, surgical technique, complications, and results.

Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus

1972 ◽  
Vol 37 (5) ◽  
pp. 548-551 ◽  
Author(s):  
Stephen Samuelson ◽  
Don M. Long ◽  
Shelly N. Chou
Keyword(s):  
High Pressure ◽  
Normal Pressure Hydrocephalus ◽  
Subdural Hematoma ◽  
Normal Pressure ◽  
Content Type ◽  
High Incidence ◽  
Symptoms And Signs ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ The authors report five patients with normal-pressure hydrocephalus (NPH) who developed subdural hematomas following shunt procedures. None of the hematomas was directly related to surgery, and all appeared after the patients had shown initial clinical improvement; one was conceivably related to trauma. These patients appear to be especially susceptible to this complication, as the high incidence of 5 of 24 cases is not seen in the treatment of high-pressure hydrocephalus. The symptoms and signs of this complication, diagnosis, and treatment are described and emphasized. It is concluded that shunting procedures for NPH should not be undertaken lightly, and rigid criteria should be applied in the selection of patients to exclude other causes of dementia.

Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal-pressure hydrocephalus

1979 ◽  
Vol 50 (4) ◽  
pp. 489-493 ◽  
Author(s):  
Svend Erik Børgesen ◽  
Flemming Gjerris ◽  
Søren Claus Sørensen
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Intraventricular Pressure ◽  
Content Type ◽  
Normal Limits ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print ◽  
High Conductance

✓ Forty patients with clinical evidence of normal-pressure hydrocephalus were studied by monitoring intraventricular pressure during a 24-hour period, and by a lumboventricular perfusion test for measurement of the conductance to outflow of cerebrospinal fluid (CSF). The purpose of the study was to investigate whether there is a relationship between intraventricular pressure and conductance to outflow of CSF, and whether it is possible to use the results from pressure monitoring in the selection of patients who may be expected to benefit from shunting therapy. The conductance to outflow was used as an evaluation factor in the selection of patients to be treated by a shunt. The conductance to CSF outflow differed by twelvefold between the lowest and highest values. The level of resting intraventricular pressure was within normal limits in all patients. Accordingly, there was no evidence of a relationship between conductance to outflow and intraventricular pressure. So-called B-waves were seen more frequently in patients with decreased conductance to outflow, but were also present in patients with high conductance to outflow. Therefore, the presence of B-waves does not imply a low conductance to outflow of CSF.

Chronic cerebellar stimulation and developmental reflexes

1977 ◽  
Vol 46 (4) ◽  
pp. 506-511 ◽  
Author(s):  
Richard D. Penn ◽  
Mary Liz Etzel
Keyword(s):  
Cerebral Palsy ◽  
Anterior Lobe ◽  
Chronic Stimulation ◽  
Content Type ◽  
Motor Disabilities ◽  
Primitive Reflexes ◽  
Developmental Scale ◽  
Motor Retardation ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ The changes in motor function in cerebral palsy patients produced by chronic anterior lobe cerebellar stimulation were documented with the Milani-Comparetti developmental scale, which allows comparison between functional gains and reflex patterns. Two patients with marked motor retardation and primitive reflexes were followed serially over several months of stimulation. Using these measures, the efficiency of chronic stimulation can be assessed, although many years will be needed to evaluate its role in treating motor disabilities.

A three-dimensional reconstruction of the human brain stem

1982 ◽  
Vol 57 (4) ◽  
pp. 491-495 ◽  
Author(s):  
Farhad Afshar ◽  
Eric Dykes
Keyword(s):  
Human Brain ◽  
Brain Stem ◽  
Computer Technology ◽  
Three Dimensional ◽  
Three Dimensional Reconstruction ◽  
Content Type ◽  
Stereotaxic Surgery ◽  
Stereotaxic Atlas ◽  
Dimensional Reconstruction ◽  
Fine Print

✓ Advances in computer technology and color graphics have been applied to the sections in a stereotaxic atlas of the human brain stem to enable three-dimensional reconstructions of nuclei and tracts. Techniques for viewing the reconstructed brain stem from multiple directions and in stereo have been achieved. The application of these methods and the use of color graphics are discussed with respect to stereotaxic surgery and computer dissection in neuroanatomical studies.

Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy

1998 ◽  
Vol 88 (1) ◽  
pp. 73-76 ◽  
Author(s):  
A. Leland Albright ◽  
Margaret J. Barry ◽  
Michael J. Painter ◽  
Barbara Shultz
Keyword(s):  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Term Therapy ◽  
Short Term ◽  
Intrathecal Catheter ◽  
Content Type ◽  
Body Regions ◽  
Before And After ◽  
Generalized Dystonia ◽  
Fine Print

Generalized dystonia occurs in 15 to 25% of persons with cerebral palsy (CP) and responds poorly to medical and surgical treatments. Object. After the authors observed a woman whose dystonic CP was dramatically improved by continuous infusion of intrathecal baclofen, they designed this pilot study to evaluate the effect of this treatment on a group of patients with dystonic CP. Methods. The authors assessed the short-term response to intrathecal baclofen infusion in 12 patients with dystonic CP. An intrathecal catheter was inserted percutaneously and connected to an external microinfusion pump. The infusion began at a rate of 100 µg/day and was increased by 50 µg every 12 hours until the dystonia abated, adverse effects occurred, or the dose reached 900 mg/day with no improvement. Two observers, one blinded and one not blinded to the patient's treatment status, viewed videotapes made before and after the infusions and graded the dystonia in eight body regions, using a 5-point scale. Overall and regional scores were compared by using Wilcoxon signed-rank tests. Conclusions. Dystonia diminished in 10 of 12 patients whose average daily dose of intrathecal baclofen was 575 µg. Overall dystonia scores and scores for the extremities, trunk, and cervical regions were significantly better after infusion (p = 0.003). The two observers' scores were not significantly different. Programmable infusion pumps were subsequently implanted in eight patients for long-term therapy and improvement was sustained in six (p < 0.05). Intrathecal baclofen infusion is a promising treatment option for generalized dystonia associated with CP. The effects of intrathecal baclofen infusion on dystonia can be evaluated by using short-term continuous infusions.

Why is joint range of motion limited in patients with cerebral palsy?

2012 ◽  
Vol 38 (1) ◽  
pp. 8-13 ◽  
Author(s):  
M. de Bruin ◽  
M. J. C. Smeulders ◽  
M. Kreulen
Keyword(s):  
Cerebral Palsy ◽  
Range Of Motion ◽  
Muscle Tone ◽  
Surrounding Tissue ◽  
Spastic Cerebral Palsy ◽  
Joint Angles ◽  
Joint Range Of Motion ◽  
Joint Range ◽  
Selection Of Patients ◽  
Selection Of

Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand and arm. Understanding why these contractures develop in cerebral palsy will affect the selection of patients suitable for surgical treatment as well as the choice for specific surgical procedures. The generally accepted hypothesis in patients with spastic cerebral palsy is that the hyper-excitability of the stretch reflex combined with increased muscle tone result in extreme angles of the involved joints at rest. Ultimately, these extreme joint angles are thought to result in fixed joint postures. There is no consensus in the literature concerning the pathophysiology of this process. Several hypotheses associated with inactivity and overactivity have been tested by examining the secondary changes in spastic muscle and its surrounding tissue. All hypotheses implicate different secondary changes that consequently require different clinical approaches. In this review, the different hypotheses concerning the development of limited joint range of motion in cerebral palsy are discussed in relation to their secondary changes on the musculoskeletal system.

Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy

1999 ◽  
Vol 91 (5) ◽  
pp. 727-732 ◽  
Author(s):  
Jack R. Engsberg ◽  
Sandy A. Ross ◽  
Tae Sung Park
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Angle Data ◽  
Work Done ◽  
Fine Print

Object. In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP).Methods. Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values.Conclusions. The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

Selection of instrumentation and fusion levels for scoliosis: where to start and where to stop

2004 ◽  
Vol 1 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Keith H. Bridwell
Keyword(s):  
Adult Patient ◽  
Degenerative Changes ◽  
Final Decision ◽  
Adolescent Patient ◽  
Lumbar Curve ◽  
Content Type ◽  
Apical Rotation ◽  
A Minor ◽  
Selection Of ◽  
Fine Print

Object. Although there are several papers in the literature regarding selection of fusion levels in the adolescent patient, fewer articles pertain to this in the adult patient. The author reviewed his experience and the literature and reports on the choice of fusion levels in the adolescent and adult patient. Methods. After a review of available data, the author determined that the proximal and distal extent of the fusion should be based on defining curves as either major or minor in the adolescent patient. It is often possible to exclude minor curves from the fusion. Relative Cobb measurement, apical deviation from the plumb line, and apical rotation are the most useful means of distinguishing a major from a minor curve. Otherwise, the proximal and distal extent of a fusion should be performed in such a way that the proximal and distal vertebrae are both neutral and stable (bisected by the center sacral line) postoperatively. Additional segments may need to be included in the adult patient in whom extensive degenerative changes and subluxations are present. The decision of whether to terminate a long fusion at L-5 or the sacrum in an adult degenerative lumbar curve is complex and many factors have to be considered. Conclusions. Guidelines exist for fusion levels in both adolescent and adult patients. Not all curves require fusion. There are many coronal and sagittal considerations that have to be analyzed when making the final decision.

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