Orientation of the neck

This disease is a head movement hyperactivity disorder, the cause of which is still unknown, but it is recognized as a basal ganglia or extrapyramidal disease, an uncontrollable clonic or paralysis caused by abnormal nerve impulses of the cervical muscles. . There are two types of surgical treatment for this disease. One is to cut or remove the muscle involved in the neck or its innervation. Another type uses directional surgery to block abnormal nerve impulses. Treating diseases: cervical diseases Indication 1. After a long period of time, there is no spontaneous remission (20% of patients can spontaneously improve, another 10% of patients can recover spontaneously), and those who have been treated for more than half a year are ineffective. 2. The tendon has exceeded the neck range (the tendon range is limited to the neck can be used for the above-mentioned affected neck muscle resection and neurotomy). Contraindications 1. The condition of the whole body is very poor or there are other serious diseases that are not suitable for the operation. 2. Those with obvious mental factors have poor surgical results and should be carefully considered. Preoperative preparation 1. Before the operation, pay attention to the physical examination of the whole body, pay special attention to the presence or absence of cardiovascular disease, and do blood and urine routine tests and EEG, electrocardiogram, liver function tests, chest radiographs, etc. 2. Patients who have been in bed for a long time and have difficulty in exercising should help to get out of bed or exercise as much as they can to enhance their heart function. 3. Patients with high blood pressure should take antihypertensive drugs to reduce blood pressure to the normal range. 4. If the patient is nervous, apply appropriate amount of sedative drugs on the day before surgery or on the night before surgery. 5. Shaving, procaine and iodine allergy tests. Surgical procedure 1. There are a variety of orientation guides installed. When installing, it is necessary to strictly follow the requirements of various types of orientation instruments and strive for standards. For example, Bintian Orientation, the patient's head position must be adjusted so that the earplugs on both sides of the frame are aligned with the external auditory canal, and the midline of the skull is aligned with the center hole before and after the frame (ie, the instrument centerline). The Leksell directional instrument must be installed with the sagittal midline of the frame coincident with the midline of the skull. The Y axis of the frame is parallel to the GI line. The head in the anteroposterior direction is located at the center of the frame, avoiding the frame reclining, leaning forward or rotating, and eliminating positioning errors as much as possible. 2. Scalp incision and skull drilling Before the coronal suture, 2.5 cm beside the midline of the surgical side to make a longitudinal incision of 3 to 4 cm long. The skull is drilled in the center of the incision, and the dura mater is cut in a "T" shape, and then electrocoagulated on the surface of the cortex for preparation of cerebral puncturing and target puncture. 3. Ventricular angiography through the skull to puncture the anterior horn of the lateral ventricle, pressure inflated ventriculography or injection of positive contrast agent 8 ~ 10ml, then take the head of the skull positive side, showing the third ventricle, interventricular hole, aqueduct, pine cone Body crypts and anterior and posterior commissures. 4. The surgical target can be in the globus pallidus or the thalamus. Cooper (1965) advocated that the lesion was made larger, with a slightly posterior position, including the second half of the ventrolateral nucleus (VL) of the thalamus, the first half of the posterior nucleus of the thalamus (VP), and the outer half of the central nucleus (CM). 3. In 130 cases, 77% of the twists were relieved. Nowadays, the thalamic nucleus is often used as a surgical target, especially the posterior effect of VL is better. 5. The production of damaged stoves is mostly by radio frequency electric heating or freezing. complication Due to the emergence and application of high-tech and advanced equipment such as stereotactic and neuroimaging, modern stereotactic surgery has developed rapidly and entered a new era of more accurate positioning, less trauma and better effects. Surgery complications have been greatly reduced compared with the past, mainly in the following categories. 1. Dyskinesia occasionally hemiplegia, balance disorder, ADHD, etc., mostly due to positioning error, vascular injury, thrombosis and edema involving the internal capsule, cerebellum-cortical pathway, subthalamic nucleus. Most of the movement disorders are temporary, but a few can exist for a long time. 2. Speech disorders include volume reduction, dysarthria and aphasia. Generally seen in bilateral surgery and superior hemisphere surgery, mostly temporary. The part related to the speech function is located in the outer upper part of the dominant hemisphere thalamus. During the operation, the patient can perform electrical stimulation when the patient continuously counts or continually naming. If there is a count or a naming interruption, the part is related to the speech function, and the damage area must be Move before the front. 3. Mental disorders are mostly temporary. The operation of the dominant hemisphere has more influence on the oral function such as counting and sentence making, and the memory disorder in recent events is more common. The operation of non-dominant hemisphere has more influence on the spatial image function such as composition and modeling. 4. Intracerebral hemorrhage may directly damage the blood vessel or localized bleeding of the damaged lesion (after secondary damage such as electrocoagulation, freezing or mechanical cutting). Systemic factors such as arteriosclerosis and hypertension are the predisposing factors for bleeding. Most of the bleeding is acute, sometimes subacute or chronic. The patient gradually developed hemiplegia after operation, the consciousness was unclear and the intracranial pressure was increased, and the condition was progressively deteriorated. Hemorrhage may be considered. CT examination can be quickly diagnosed. The only treatment is timely craniotomy.

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