Stereotactic surgery

METHODS OF LESION MAKING

Heat - radiofrequency current delivered through a fine electrode 1 lesion size

Cooling - with a cryogenic probe J determined by

Radiation - implantation of radioactive seed, e.g. yttrium110 temperature

- focussed beam from cobalt*'0 rods (sited on a specially change and adapted Leksell frame) or from a linear accelerator. duration.

USES OF STEREOTACTIC SURGERY Movement disorders

- tremor 1 lesions in

- dystonia f thalamic

- spasmodic torticollis J nuclei

- spasticity - lesion in dentate nucleus or pulvinar.

- dyskinesia - lesion in globus pallidus

LESION-MAKING

Pain - especially intractable head or neck pain in malignancy.

- Lesion in centromedian nucleus of the thalamus and intralaminar nuclei, or descending tract of the trigeminal nucleus.

Psychosurgery

Obsessive and compulsive illness Intractable depression

Bilateral cingulotomy.

Subcaudate tractotomy stimulation

Movement disorders <

Pain - intractable pain, unresponsive to other measures spasticity - cerebellar stimulation tremor - thalamic stimulation

- stimulation of the thalamic relay nuclei, internal capsule, periaqueductal or periventricular grey matter aspiration biopsy -

irradiation cyst, abscess, or haematoma particularly for small and deeply situated tumours

, implantation of radioactive seeds, e.g. craniopharyngioma

■ external stereotactic irradiation appears useful in the treatment of small deep arteriovenous malformations

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