Microeletrode guided stereotactic pallidotomy and pallido-thalamotomy for treatment of Parkinson's disease

Objective. Authors evaluated the therapeutic effect of the MRI and microelectrodeguided stereotactic pallido- and pallido-thalamotomy in 33 patients with Parkinson's disease (PD), whose symptoms were refractory to pharmacological therapy. Matherial and methods. The patients were evaluated according to the internationally standardized rating scales (UPDRS part II, III, Schawb & England, Hoehn & Yahr, and Fahn) at six timepoints: before the operation, and 2 days, 3, 6, 9 and 12 months postoperatively. The patients were divided into 2 groups. Those in group A had relief of all main parkinsonian symptoms after pallidotomy including tremor. The patients in group B had no relief of tremor after pallidotomy. For them the pallidotomy was completed by thalamotomy in the same sitting, which had resulted in cessation of tremor. Results. The following results were obtained by using the UPDRS part III: after pallidotomy "On state" mean: preoperative 51,2, postoperative at 211 day 29,5 at 3, 6 and 9(th) month 26, and at 12(th) month 28,7. "Off state" mean: preoperative 64,3, postoperative at 2(nd) day 31,6, at 3, 6 and 9(th) month 26, and at 12(th) months 30,5. After pallidothalamotomy "On state" mean: preoperative 43,5, postoperative at 2(nd) day 27,9, at 3(rd) month 22,9, at 6(th) month 22,8, and at 9 and 12(th) month 24,5. "Off state" mean: preoperative 62,6, postoperative at 2(nd) day 38, at 3(rd) month 30, at 6(th) month 31,8 and at 9 and 12(th), month 33,8. Conclusions. For those patients, whose tremor was not successfully controlled by pallidotomy, the combined pallido-thalamotomy was effective. The clinical symptomps, according to the rating scales, improved significantly in both groups (student t: P < 0,0001), but bilateral lesioning carried higher surgical morbidity.