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Pallidotomy

The history of this operative procedure in Parkinson's diseases is fascinating, in that in 1960 Svennilson and Leksell had noted that in the last 20 of their series of 81 Parkinsonian patients who had had a thermolytic lesion of the globus pallidus , there was a marked relief of tremor and rigidity. In these last 20 cases, the surgeons had altered the area to be lesioned from the anterodorsal to the posteroventral region of the medial globus pallidus (GPm). These results were largely overlooked for the next 2 decades, until:

  • In 1992, Laitinen et al described 38 patients with Parkinson's in whom he had performed a lesion of the posteroventral region of the GPm. 37 patients had a marked improvement in their rigidity and hypokinesia.
  • In the early 1990s, as a result of studies using the model of MPTP-induced parkinsonism in monkeys, a much greater understanding of the neurophysiological pathways involved in Parkinson's became more clear. In particular, hyperactivity of the subthalamic nucleus and overexcitation of its efferent targets were found to be a hallmark of PD.

Over the last few years, a number of groups have reported encouraging results for this procedure for patients with severe Parkinson's disease resulting in:

  • reduced 'off' period disability and decreased 'off' hours
  • improvements in activities of daily living
  • a marked reduction in levodopa induced dyskinesias
  • other common problems of Parkinson's disease, such as tremor, freezing, speech disturbance etc may improve post-operatively but these are less predictable.

The main risks of surgery are:

  • hemiparesis
  • facial weakness
  • frontal lobe signs
  • visual field deficit
  • seizure
  • mortality (2 out of 128 cases in DeLong's series)

The operation itself is a lengthy procedure in which patient co-operation plays an integral part if the operation is to be successful. Thus if you are a patient with Parkinson's, it is important that these issues are discussed with your own neurologist/neurosurgeon further before proceeding.

The greatest effect of pallidotomy is predominantly contralateral to the side that was lesioned, but ipsilateral improvements have been noted in some patients.

Source: Pallidotomy


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