定位脳手術に関する研究—新しく考案した定位脳手術装置および自動温度調節付高周波凝固装置

NEW STEREOTAXIC APPARATUS AND HIGH:FREQUENCY COAGULATOR WITH THERMOREGULATOR

I．緒言

　錐体外路性疾患，てんかん，疼痛，精神病などの治療のため，近年とみに定位脳手術の適応が盛んになりつつある。定位脳手術の定義は，装置を使用することにより十分な精確度をもつて挿入針または電極を挿入し，他の非目標部位を損傷することなく目標点のみを破壊，遮断することである。その特徴は手術侵襲が軽度で手術併発症，手術死亡率を最小限にまで低下せしめうることである。その歴史はClark^3）（1920）がHorsley^17）との協同で動物実験用に1908年に始めた装置にその発祥をみる。人体ではSpiegel, Wycis^34）の1947年の発表およびわが国における楢林^27）の1951年の報告が最初であって，その後多くの手術法，手術装置が考察されてきている。その主なものは，Spiegel, Wycis^35）（1947,1952,1959，1960），　Leksell^19）20）（1949,1951,1957,1960），　Talai—rach^36）37）（1949,1952），　楢林^39）（1950），　Riechert, Wolff＆Mundinger^30）31）（1951,1954,1955），　Hayne＆Meyer^16）（1950），　Bailey＆Stein^2）（1951），　Guiot^9）（1953），　和田^41）（1953），　Mark, Mc-Pherson＆Sweet^21）（1954），　Delgado^6）（1954），　陣内^18）（1955），　竹林，駒井^38）（1956），　Cooper^4）（1956），　Obrador^28）（1957），　半田^10）（1958），　佐野^32）（1959），　Schaltenbrand^33）（1959, 1561）らがあり，またこれらの改良型を入れれば現在30種以上になる。これらの手術装置は大別して

　1） Clarkに端を発し，皮膚上より頭蓋を固定し単にレ線写真による修正で目標点に達するSpiegel—Wycis，　楢林型（和田，Bailey, Stein）。

The way of measurement which is applied for our stereotaxic apparatus is similar to the original method developed by Riechert and Mundinger. Fifty cases operated upon using this apparatus did show very satisfactory results.

Characteristics of this instrument are as follows : 1) This apparatus is able to hold the head so steadily that cases with marked tremor or other kinds of involuntary movement can be operated under local anestheia.

2) Measurements are usually made on a pair films of anteroposterior and lateral projection only. Then only one X-ray film exposure is needed to confirm if the needle tip is placed in the target after the needle being introduced into the brain.

3) Even in unskilled hands it can not be happened to have to replace the needle because of wrong direc-tion. Stereotaxic introduction of needle into the corrept place is possible and perfect even if the case was one's first experience with this apparatus.

4) Standard deviation of erroneous placement of the needle tip is only below ± 0. 5 mm from the correct point.

5) Introduction of a needle into the skull from any direction could be made. Transnasal approach to the pituitary is also feasible.

6) When one use an accesory needle-holder which is attatched to this set several electrodes can be in-serted into the brain stereotaxically from any desired direction, for example in the treatment for epilepsy. However, it should be kept in our mind that standard error of this needle tip from the target is some of ±1.0 mm in this situation.

High frequency coagulator with automatic thermore-gulator :

Temperature of the tip of the coagulator needle is automatically controlled. Therefor, after the set being a justed at a desired temperature (usually 70℃) and duration of coagulation-time everything is expected to work automatically using servomechanism. Overheat-ing of the needle tip is prevented with an automatic thermocontroling device which is snugly placed in the tip. This brings us a tremendous advantage to pre-vent hemorrhage in the site coagulated controling the size of the lesion as wanted at the same time.