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CNAA / Theses / 2004 / June /

Talamotomia stereotaxică in tratarea maladiilor extrapiramidale


Author: Valeriu Matcovschii
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2004
Scientific adviser: Grigore Zapuhlih
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.13
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 23 June, 2004
Approved by NCAA on the 14 October, 2004

Abstract

Adobe PDF document0.33 Mb / in romanian
Adobe PDF document0.27 Mb / in romanian

Keywords

stereotaxy, stereotaxic device, stereotaxic destruction, the coordinate system, electric stimulation, stereotaxic target, intracerebral electrode

Summary

This work is is based on the 14 years own experiences of realization stereotaxic operations at the patients with extrapyramidal pathology During 1988 - 2002 years in Republican Clinical Hospital and Scientific Centre of neurology and neurosurgery was carried out 93 of stereotaxic operations to 71 patients. Among them 47 was suffered Parkison disease, 13 -Cerebral palsy, and 11 various hyperkinesias sindroms. In all cases the indication to surgical treatment was unsuccessful pharmaceutical treatment not less than 2-3 years.

The operations were carried out in specialized, stereotaxic X-ray operation room, wich was shielded from electromagnetic and x-ray radiation. Operational is equipped with stereotaxic system of an own design, stationary X-ray device, electroencephalograf, electrostimulant, and vidiomonitoring system . Specific own design devicyes are cryodestructor, intracerebral diagnostic chronic electrodes and chemoelectrodes . All operations are carried out with use local anesthesia at definite consciousness of the patient. For construction intracerebral coordinates system was applied long-focus Xray grafia.

Stereotaxic operation is multi steps procedure. It consist: the fixing of a head in stereotaxics device, choice a brain target, the constructions intracerebral coordinates system, spatial modeling of a target, introduction a diagnostic electrode and realization electrostimulation, electropolarization, introduction of anesthetics in subcortical target, X-ray control of accuracy of anatomic hit in the target and realizations of cryodestruction.

Most frequently as a target we got out ventrolateral nucleus of thalamus. All patient were carried out electrical, stimulation, and less part of the patientelectropolarization, introduction anesthetics in a sucortical nucleus, electrosubcorticografy, electromyografy. The sequence and carefulness of performance of each stage is obligatory and predetermines final success of operative intervention. The special importance have a mechanical accuracy of stereotaxics device, accuracy of X-ray method of construction intracerebral coordinates system, functional and X144 ray control of cryodestructors hit in the necessary subcortical structure, clear consciousness, and high-grade speech contact to the patient, realization at first trial and after then basic cryodestruction.

In the work is showed that venterolateral nucleus of thalamus is an universal stereotaxic target for many extrapyramidal diseases, present high opportunities stereotaxics telerengenografy, additional diagnostic opportunities of chronic intracerebral electrodes, and technique of temporary chemical blocking subcortical structures. Overseeing for operated patients varied from 1 till 14 years. The results of research prove high efficiency of venterolateral thalamotomy at the patients with drug resistance extrapyramidal diseases. So we have got 71 % good and 14 % of satisfactory results at the Parkinsonians patients. More than half case good results at the Cerebral palsy patients and 81% good results at the patients with subcortical tremor.