A SIMPLIFIED NEUROSURGICAL TECHNIQUE FOR APPROACHING AND DAMAGING THE REGION OF THE GLOBUS PALLIDUS IN PARKINSON'S DISEASE*

Since Victor Horsley first attempted the treatment of involuntary movements by removing motor cortex, many operations have been tried for tremor and other related symptoms. Recently the interest of the neurosurgeons has been focused on the region of the globus pallidus and its pathways for the production and maintenance of Parkinsonian symptoms (Meyers, 1942; Cooper, 1953; Spiegel and Wycis, 1954). The great advantage claimed for this type of subcortical operation is that tremor and rigidity are improved or relieved without affecting voluntary power. The operations on the pallidal region can be divided into three main groups: A, Stereotaxic approach and production of lesions by electrolysis or coagulation (Spiegel and Wycis, 1954; Hassler and Riechert, 1954); B, open approach to the subcortical regions (Meyers, 1942; Guiot and Brion, 1953); C, closed methods of tapping, coagulating, or chemical destruction (Fenelon, 1950; Cooper, 1954; Cooper and Poloukhine, 1955). The stereotaxic methods are undoubtedly the most exact, but also slow, time-consuming, and tedious for a busy neurosurgical department. On the other hand, the open methods of approach involve a definite surgical risk, and this has to be considered carefully in the treatment of diseases that have no spontaneous mortality. For all these reasons, we have tried to develop a quick, safe, and surgically closed method for reaching and placing lesions in the pallidal region of Parkinsonian patients, and we have evolved a technique which we have used in six cases. The relatively large size of this region makes the closed approach easy and fairly accurate. Although we cannot speak about the long-term results of this operation, as sufficient time has not yet elapsed, we have however considered it worth reporting our surgical methods for making small and deep cerebral lesions.