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Pallidotomy

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Pallidotomy

Pallidotomy
Intervention
ICD-9-CM 01.42
MeSH

Pallidotomy is a neurosurgical procedure whereby a tiny electrical probe is placed in the globus pallidus (one of the basal nuclei of the brain), which is then heated to 80 °C (176 °F) for 60 seconds, to destroy a small area of brain cells.

Pallidotomy is an alternative to deep brain stimulation for the treatment of the involuntary movements known as dyskinesias which can become a problem in people with Parkinson's disease after long-term treatment with levodopa — a condition known as levodopa-induced dyskinesia.[1] It is also sometimes used in alternative to deep brain stimulation to treat difficult cases of essential tremor.[2]

The Internal globus pallidus can be regarded as an "output structure" of the basal ganglia,[3] processing input from nucleus accumbens and the striatum and sending input to the cerebral cortex via the thalamus. Thus, it is critical for the functioning of the basal ganglia. Unilateral posteroventral pallidotomy can be effective at reducing Parkinsonism, but is associated with impaired language learning (if performed on the dominant hemisphere) or impaired visuospatial contructional ability (if performed on the non-dominant hemisphere). It can also impair executive functions.[4] Bilateral pallidotomy will not reduce Parkisonistic symptoms but will cause severe apathy and depression along with slurred, unintelligible speech, drooling, and pseudobulbar palsy.[5][6]

History

Stereotactic pallidotomy was pioneered by Dr. Hirotaro Narabayashi.

References

  1. ^ Oertel, W.H.; Berardelli, A.; Bloem, B.R.; Bonuccelli, U.; Burn, D.; Deuschl, G.; et al. (2011). "Late (complicated) Parkinson's disease" (PDF). In Gilhus, Nils Erik; Barnes, Michael R.; Brainin, Michael. European Handbook of Neurological Management I (2nd ed.). Blackwell. pp. 240–1.  
  2. ^ Hooper, Amanda K.; Okun, Michael S.; Foote, Kelly D.; Fernandez, Hubert H.; Jacobson, Charles; Zeilman, Pamela; Romrell, Janet; Rodriguez, Ramon L. (2008). "Clinical Cases where Lesion Therapy Was Chosen over Deep Brain Stimulation". Stereotactic and Functional Neurosurgery 86 (3): 147–52.  
  3. ^ Middleton, Frank A.; Strick, Peter L. (2000). "Basal Ganglia Output and Cognition: Evidence from Anatomical, Behavioral, and Clinical Studies". Brain and Cognition 42 (2): 183–200.  
  4. ^ Trepanier, L. L.; Saint-Cyr, J. A.; Lozano, A. M.; Lang, A. E. (1998). "Neuropsychological consequences of posteroventral pallidotomy for the treatment of Parkinson's disease". Neurology 51 (1): 207–15.  
  5. ^ Merello, M; Starkstein, S; Nouzeilles, MI; Kuzis, G; Leiguarda, R (2001). "Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation". Journal of Neurology, Neurosurgery & Psychiatry 71 (5): 611–4.  
  6. ^ Ghika, Joseph; Ghika-Schmid, Florence; Fankhauser, Heinz; Assal, Gil; Vingerhoets, François; Albanese, Alberto; Bogousslavsky, Julien; Favre, Jacques (1999). "Bilateral simultaneous posteroventral pallidotomy for the treatment of Parkinson's disease: Neuropsychological and neurological side effects". Journal of Neurosurgery 91 (2): 313–21.  
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