Combined transtentorial dentatotomy with pulvinarotomy in cerebral palsy

For frequently associated spasticity with involuntary movements in cerebral palsy operations on cerebellar nuclei or on the pulvinar of the thalamus are recommended. We combined both approaches in 45 patients. The combination was possible after experiences with transtentorial dentatotomy, in which the electrodes are introduced into the deep structures of the cerebellum from a burr-hole on the lambdoid suture. The same lambdoid approach may equally well be applied for introducing electrodes into the pulvinar of the thalamus. The lesion in the pulvinar may moreover be combined with the target in the centrum medianum or in the nuclei VIM-VCP or VOP. Lesions are always asymmetric and multilocular. Their influence on the clinical picture is quite favourable.