Lesions of the Centrum Medianum in the Treatment of Movement Disorders

Bilateral Implantation of Centromedian-Parafascicularis Complex and GPi: A New Combination of Unconventional Targets for Deep Brain Stimulation in Severe Parkinson Disease

“…However, the combined implantation of CM/Pf plus Gpi, as shown in this study, or implantations within STN (our more recent ongoing series, in preparation) has proved to be of value. The stimulation effects of DBS within the CM‐Pf complex plus stimulation of GPi is consistent with the old observations of Adams and Rutkin (8), who claimed that lesioning of the intralaminar thalamic complex was clinically efficacious, if performed with other targets.…”

“…Both CM and Pf, however, were already tested in the late 1960s as potential target structures for amelioration of motor impairment. Aside from these pioneering observations (8), there have been some good clinical results reported that use the gamma knife procedure on these targets (9). Caparros‐Lefevre and coauthors proposed the involvement of CM‐Pf in order to explain the efficacy of thalamic DBS in affecting l ‐dopa–induced dyskinesias (10).…”

Central Median Lesions – Analysis of 89 Cases

“…N arabayashi [23,24] felt the aggravation of the dys tonia by sensory input was due to a lowering of the 'threshold for transmis sion from sensory to motor system'. Adams and R utkin [1] felt that a lesion in the CMN interrupts various converging fiber systems and destroys the cells of origin of the efferent neurons to the putamen, both of which may be critical in the genesis of movement disorders.…”

“…Connections have been proved to exist between the CMN and other areas of the brain, like the globus pallidus, the putamen, the reticular system and the cortex [7,25,26]. Thus, this nucleus forms part of a servoloop comprising the cortex, striatum, pallidum and hypothalamus [1], Fibers from the cerebellum on their way to the ventro lateral nucleus of the thalamus pass through the CMN [19]. Based upon such knowledge and on our own experience in the stereotactic treatment of various disorders, we have been choosing the CMN as a target for lesions in many cases.…”

Surgical control of the human thalamocortical dysrhythmia: II. Pallidothalamic tractotomy in Parkinson's disease

“…The introduction of the stereotactic technique in neurosurgery (Spiegel et al, 1947) allowed a more precise and less dangerous exploration of the pallidum and ansa lenticularis (Guiot and Brion, 1953;Narabayashi and Okuma, 1953;Riechert and Wolff, 1953;Cooper, 1954;Spiegel and Wycis, 1954). Different nuclei of the thalamus have been proposed at different times, including the posterior half (Hassler and Riechert, 1954) or anterior half (Molina-Negro, 1979) of the anterior part of the ventral lateral nucleus (VLa, or ventrooralis of Hassler, 1982), the posterior part of VL (VLp, or ventralis intermedius of Hassler, 1982) by Cooper and Bravo (1958), the ventral medial nucleus (Cooper, 1969), the anterior part of the ventral posterior lateral nucleus (Tasker et al, 1988) as well as intralaminar nuclei (Adams and Rutkin, 1965). Different nuclei of the thalamus have been proposed at different times, including the posterior half (Hassler and Riechert, 1954) or anterior half (Molina-Negro, 1979) of the anterior part of the ventral lateral nucleus (VLa, or ventrooralis of Hassler, 1982), the posterior part of VL (VLp, or ventralis intermedius of Hassler, 1982) by Cooper and Bravo (1958), the ventral medial nucleus (Cooper, 1969), the anterior part of the ventral posterior lateral nucleus (Tasker et al, 1988) as well as intralaminar nuclei (Adams and Rutkin, 1965).…”