Secondary Degemeration of the Pyramidal Trat following Cerebral Hemispherectomy in a Man

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Sim, Bo-Sung
Issue Date
서울대학교 의과대학
Seoul J Med 1960;1(1):69-80
Dandy8) in 1928 performed the first cerebal hemipherectomy
in patients with infiltrating gliomas and
Krynauw~O) in 1950 carried out a similar operative
procedure in patients with infantile type hemiplegia
associated with uncontrollable convulsions and mental
aberrations. Subsequently many surgeons have
performed the procedure (Table I and II.) and it is
this material that has permitted further assessment
of the various tracts and reflex arcs in the central
nervous system. Among the observed phenomena
has been the postoperative retention of some of the
contralateral motor and sensory functions , especially
in those patients who preoperatively had partial
loss of these abilities.
Karnosh17) (1937) made sections of the lower pons
just above the pyramidal decussation in a patient
who survived 29 days after riiht cerebral hemispherectomy
for a brain tumor. He used myelin sheath
staining methods. These sections revealed a demyelinized
pyramidal tract at the decussation , but those
fibers which were destined to remain uncrossed showed
no such defect. Lassek and Evans2D (1945) reported
that of three cases of human cerebral hemispherectomy
for the removal of brain tumors, one
patient survived for 330 days after operation. Stained
sections of the brain stem in this case showed
fibers in the pyramidal tract other than those originating
in the cerebral cortex. PoweW29)(1952) described
the residual neurons in the thalamus in a patient
who survived for 24 days after the cerebral
hemidecortication. Austin and Grant2) (1955) described
their observations in four patients of right-sided
hemispherectomy in adults. In one patient who survived
two and one-half months postoperatively, thalamie
sections revealed a complete ipsilateral degeneration
of the nucleus ventralis posteromedialis.
Except for these four reports no anatomical study
of the cenetral nervous system after cerebral hemispherectomy
has been reported in human cases.
The purpose of this study is to present clinical and
anstomical observations on the effect of cerebral
hemispherectomy in a man.
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)The Seoul Journal of MedicineThe Seoul Journal of Medicine Vol. 01 No.1 (1960)
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