Role of stereotaxis in the treatment of cerebral palsy.
There is a renewed interest in basal ganglia surgery for improvement of motor symptoms in cerebral palsy. Rigidity, choreoathetosis, and tremor can be improved or abolished by a well-placed radiofrequency lesion, either in the ventrolateral nucleus of the thalamus or ventroposterior pallidum. The target is chosen based on the predominance of the symptoms in a given patient. A review of the main reports on surgery of the basal ganglia for cerebral palsy, as well as the author's data, shows that the surgery can have a remarkable impact on patients' quality of life when motor dysfunction is improved. An update of the physiopathology of cerebral palsy motor symptoms related to anatomic findings on experimental work, magnetic resonance imaging, and autopsy is used to rationalize surgery of the basal ganglia. Modern stereotactic technique based on exquisite demonstration of the basal ganglia anatomy by magnetic resonance imaging is described and supported by intraoperative electricophysiologic studies. The author stresses the importance of a multidisciplinary approach to provide the cerebral palsy patient with a comprehensive treatment plan before stereotactic surgery.
De Salles
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Division of Neurosurgery, University of California Los Angeles School of Medicine 90024-6975, USA.
D000293:Adolescent; D001479:Basal Ganglia / Q000601:surgery*; D002547:Cerebral Palsy / Q000145:classification / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D013238:Stereotaxic Techniques; D016896:Treatment Outcome