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FUNCTIONAL ANATOMY OF THE INTERNAL MEDULLARY LAMINA BASED ON THE RESULTS OF STEREOTAXIC SURGERY Norio Yoshimasu 1 1Department of Neurosurgery, University of Tokyo pp.1277-1292
Published Date 1972/10/1
DOI https://doi.org/10.11477/mf.1406203197
  • Abstract
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1) Cases of intractable pain treated by stereotaxic lesion of the internal medullary lamina of the thalamus (Thalamolaminotomy) were followed up. In 4 autopsy cases the thalamolaminotomy lesions corresponded correctly with the target checked by X-P according to Schaltenbrand-Bailey atlas. But the degree of the dilatation of the third ventricle must be taken into consideration for the mesure-ment of lateral distance from the midline. Effect of the relief of pain was better in the cases with bilateral large lesions of the internal medullary lamina including Centrum-medianum Parafascicular complex (CM-Pf) (Namely thalamolaminotomy) than those with the lesion only in the CM-Pf or Pf.

2) Degenerating fibers from the lesions were studied by Nauta-Gygax method. In all cases terminal degenerations are found in the specific nucleus of the thalamus, namely nucleus Ventro-caudalis parvocellularis (Vc. pc.). Some other de-generated fibers were seen in the IV-VI layers of the second sensory cortex.

3) The neurons which responded to the pin prick stimulation on almost all over the body were found in Pf. nucleus of the thalamus. Evoked responses were recorded on the second sensory cortex by electrical stimulation of CM. nucleus in the inter-nal medullary lamina. Evoked potentials were also obtained in the area of hand representation of the second sensory cortex by the stimulation of the contra-and ipsilateral median nerves. In this area single neurons, which responded to the same stimu-lation with the latency of about 45 msec were found. In one case of pharyngeal cancer, ablation of the contralateral second sensory cortex was effective for relief of pain.

4) It may be supposed that the internal medullary lamina of the thalamus relays a part of the pain impulses and in turn it has also some influences on the specific sensory nucleus of the thalamus, which relays epicritic sensation.

These findings suggest that the internal medullary lamina has connections with the second sensory cortex not only via the specific nucleus of the thalamus but also direct projections to it.

The first and second sensory cortex also seem to have regulatory activity on the specific and non-specific nuclei of the thalamus and the reticular formation of the brain stem.

Effective treatment for relief of pain must include large destruction of the bilateral internal medullary lamina. And corticectomy of the second sensoryarea may be also effective in some cases.


Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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