RESUMO
Posteroventral pallidotomy has already been considered the surgical procedure of choice for Parkinson's disease patients with motor complications. Recently, however, several factors led to its replacement by deep brain stimulation. Nevertheless, pallidotomy has a well-documented efficacy and safety evidence regarding the reduction of parkinsonian motor symptoms. Yet, there may be manysituations where it may be considered as a better option than neuromodulation. Herein we review those possible conditions, giving emphasis to the costs, which we found to be the most limiting factor. Importantly, a cost comparison between deep brain stimulation and pallidotomy was also provided.
Assuntos
Técnicas de Ablação , Estimulação Encefálica Profunda , Palidotomia , Doença de Parkinson/cirurgia , Técnicas de Ablação/economia , Técnicas de Ablação/métodos , Técnicas de Ablação/normas , Estimulação Encefálica Profunda/economia , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/normas , Humanos , Palidotomia/economia , Palidotomia/métodos , Palidotomia/normasRESUMO
With the rapid increase in provision of deep brain stimulation for Parkinson's disease, the efficacy of pallidotomy in symptom alleviation appears to be increasingly ignored. We demonstrate that lesional surgery is effective with benefit over a significant period of time with very significant societal cost savings. Such studies are essential for future planning of services so that maximum numbers of patients can benefit from surgery, both lesional and neuromodulation, as deemed appropriate.
