1-30-18 Preliminary results in surgery of Parkinson's disease

Abstract

-The authors present the preliminary results of 20 patients selected to be operated on between January 1996 and April 1997. These patients presented one of the present indications for stereotactic posteroventral pallidotomy (PVP), such as: rigidity, akinesia/bradykinesia, gait dysfunction, drug induced dyskinesias and tremor. Every patient of this protocol was evaluated by: UPDRS score, Schwab and England scale, Hoehn and Yahr Staging Scale before and after surgery. The results in 3 months showed a remarkable improvement after PVP (P<0.01) in all functional assessments, except for facial expression, speech and posture. The morbidity was 5%. 5 patients (25%) who were in Hoehn and Yahr 5 underwent a bilateral simultaneous PVP. In 5 patients (25%), who had tremor, during the PVP, VIM thalamotomy was added. These preliminary results suggest that PVP is highly effective for PD symptoms.KEY WORDS: Parkinson's disease, postero-ventral pallidotomy, VIM thalamotomy, simultaneous bilateral postero-ventral pallidotomy, stereotaxis. Resultados preliminares em cirurgia na doença de ParkinsonRESUMO -Os autores apresentam seus resultados iniciais, no período de janeiro de 1996 até abril de 1997, em pacientes selecionados para cirurgia. Todos apresentavam indicação para palidotomia póstero ventral (PPV), como: rigidez, acinesia/bradicinesia, distúrbio da marcha, discinesia induzida por medicamentos e tremor. Todos os pacientes do protocolo foram submetidos a: UPDRS, escala de Hoehn e Yahr, escala de Schwab e England antes e após a cirurgia. Os resultados mostraram melhora significativa nos 3 meses iniciais (p<0,01) para todas as provas motoras exceto para expressão facial, postura e fala. A morbidade foi de 5%. 5 pacientes em Hoehn e Yahr 5 foram submetidos a palidotomia bilateral simultânea. 5 talamotomias (núcleo VIM) foram acrescentadas no mesmo tempo para pacientes com tremor. Os resultados sugerem que PPV é um procedimento seguro e altamente eficaz para os sintomas da doença de Parkinson. PALAVRAS-CHAVE: doença de Parkinson, palidotomia póstero-ventral, talamotomia VIM, palidotomia póstero-ventral simultânea, estereotaxia.The understanding of pathophysiology of Parkinson's disease (PD), the signs and symptoms and also the improvement of modern techniques in neuroradiology, functional neurosurgery and neurophysiology assessment have renewed the right place of surgery in PD. Leksell's posteroventral pallidotomy (PVP) 1,2 has become the procedure of choice. The indications are: rigidity, akinesia or bradykinesia, muscle pain, L-Dopa induced dyskinesias and resting tremor. Ventrolateral thalamotomy is more indicated for those PD patients with resting and intention tremor, and those who initially did not respond to pallidotomy for tremor. It is not uncommon a combination peroperatively of pallidotomy and ventralis intermedius (VIM) thalamotomy if the tremor does not respond satisfactorily after PVP 1,[3][4][5] . This paper report the authors preliminary results on PVP in PD.