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Surgical Treatment for Parkinsonism.
Dr. Bertram Feinstein, San Francisco.Stereotaxic techniques for placing subcortical lesions provide an effective approach for the treatment of certain dyskinesias. The first phase of our current procedure consists of fixing the inner square frame of a Leksell stereotaxic instrument to the skull by means of special inserts. These are left in position to provide a means for precise repositioning of the frame on subsequent occasions. The anterior and posterior commissures of the third ventricle, and the midline which serve as reference points are demonstrated by pneumoencephalography or iodoventriculography. About a week later, using only a local anesthetic and no sedation, thermal lesions are produced by using high-frequency current to heat the tissue at the tip of the positioned electrode. The stereotaxic instrument may be adjusted easily without repeating the localizing phase. This permits the incremental production of lesions, so that optimum improvement may be obtained