Magnetic Resonance Image Guided Unilateral Pallidotomy for Parkinson's Disease; Surgical Technique and Clinical Efficacy

OBJECTIVE: The authors present a clinical analysis to determine the clinical efficacy of unilateral palliotomy for Parkinson's disease without microelectrode recording procedure and to review the surgical technique, based on the anatomical landmark using magnetic resonance(MR) image. METHODS: Twenty-seven patients were retrospectively studied with extensive neurological examinations including Unified Parkinson's Disease Rating Scale(UPDRS) in 'levodopa-on and -off' tate before and at 6 and 12 months following MRI-guided pallidotomy. Lesion location was characterized using thin sliced MR image and measured on axial slice of TOF image. Lesion was performed with radiofrequency lesion generator. RESULTS: Final surgical target was 2.7+/-0.3mm in front of the intercommissural point, 4.0+/-1mm below the imtercommissural line, and 20.2+/-1.4mm lateral to the midline of the third ventricle. Significant improvements were observed in the total UPDRS scores and motor scores. And there was no significant postoperative complication and sequale except transient paresis(2 cases) and dysarthria(1 case). CONCLUSION: Steretotactic MR image guided pallidotomy with macrostimulation for the patients with Parkinson's disease is safe with minimal morbidity and significantly reduces the disabilities of Parkinson's disease.

Treatment of Parkinson's Disease by Streotactic Thalamotomy and Pallidotomy

The authors report the surgical results of thalamotomy and pallidotomy, performed at our hospital between 1983 and 1993 for the treatment of Parkinson's disease. The series included a retrospective analysis of 156 patients with this condition by stereotactic ventrolateral(VL) thalamotomy(126 patients, 138 thalamotomies) and posterolateral pallidotomy(30 patients, 30 pallidotomies). Each patient was followed up postoperatively, for one year. Among those who underwent the stereotactic VL thalamotomy, 136/138 procedures(99%) led to improvement of tremor, and 83/138(60%) resulted in reduced rigidity. Stereotactic posterolateral pallidotomy, led to improvement of bradykinesia after 27/30 procedures(90%), of rigidity after 22/30(73%) and of tremor after 13/30(43%). Drug-induced dyskinesia showed a 42% improvement in the thalamotomy series and a 93% improvement in the pallidotomy series; the difference between the two series was significant(p0.557). In addition, for groups with greater preoperative disability(Hoehn & Yahr staging, groups III and IV), improvement was more likely after pallidotomy than after thalamotomy. In the pallidotomy series, dysphasia was the only serious complication and this was seen after 20% of procedures. In the thalamotomy series, however, complications included hypotonia(24%), transient confusion(19%), transient dysphasia(11%), permanent dysarthria(7%), subjective numbness(4%) and epileptic seizure(3%). The authors believe that posterolateral pallidotomy is much more effective than VL thalamotomy for the control of Parkinsonian bradykinesia and rigidity, but that thalamotomy is still a useful surgical option for the control of Parkinsonian tremor.