| Pallidotomy | |
|---|---|
| Intervention | |
| ICD-9-CM | 01.42 |
| MeSH | D053860 |
Pallidotomy is a procedure where a tiny electrical probe is placed in the globus pallidus (one of the basal ganglia of the brain), which is then heated to 80 degrees celsius for 60 seconds, to destroy a small area of brain cells. Pallidotomy is used to treat dyskinesias in patients with Parkinson's disease.
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In a pallidotomy, the surgeon destroys a tiny part of the globus pallidus by creating a scar. This reduces the brain activity in that area, which may help relieve movement symptoms such as tremor and rigidity.
Before surgery, detailed brain scans using MRI are done to identify the precise location for treatment.
The patient is awake during the surgery, but the scalp area where instruments are inserted is numbed with a local anesthetic. The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location. Liquid nitrogen is then circulated inside the probe. The cold probe destroys the targeted brain tissue. The probe is then removed, and the wound is closed.
The surgery usually requires a 2-day hospital stay. Most people recover completely within about 6 weeks.
Pallidotomy may be considered when a patient with advanced Parkinson's disease has:
The most striking effect of pallidotomy is a reduction in dyskinesias that are caused by long-term levodopa therapy. This improvement can be seen almost immediately. By reducing these side effects, pallidotomy enables some patients to adjust their levodopa dosage, allowing for better symptom control.
Pallidotomy may reduce tremor, muscle rigidity, bradykinesis, and other motor symptoms. Balance and speech may also be improved.
It is not known how long the effects of pallidotomy can be expected to last. Benefits may fade over time in some people.
Doctors rarely perform pallidotomy anymore. Instead, doctors use deep brain stimulation, a procedure that does not destroy brain tissue and has fewer risks than pallidotomy.
This type of brain surgery has less risk today than in the past because technology allows the surgeon to identify with great precision the area of the brain that will be treated. Serious permanent complications are not common, although less serious side effects are.[1]
Complications of pallidotomy can include a stroke caused by bleeding in the brain.
Many people who have a stroke recover fully and benefit from pallidotomy. Pallidotomy has caused problems with thought and memory (cognitive impairment) in some people.[1]
Other risks include:
Stereotactic pallidotomy was pioneered by Dr. Hirotaro Narabayashi.
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