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

ABSTRACT

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.