Gamma knife pallidotomy: Case report

Bonnen, J. G.; Iacono, Robert P.; Lulu, B. A.; Mohamed, A. S.; González, A. Prieto; Schoonenberg, T.

doi:10.1007/bf01808881

Cited by 18 publications

(16 citation statements)

References 21 publications

(34 reference statements)

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“…In a series by Friehs et al, 21 140 lesions produced with the GK for PD, pain, or other disorders varied in size from undetectable to 4000 mm 3 (collimator sizes for all studies were 4 mm). It has been previously reported, 10 as in patient 8, that MRI changes with the GK may be absent even in the presence of a clinical deficit.…”

Section: Problems With Lesion Sizementioning

confidence: 89%

“…Two major factors contribute to this problem: the size of the collimator and the potentially progres- 10 Early lesions, made with the 8-mm collimator for GK pallidotomy and thalamotomy, were larger than expected; therefore, most groups switched to the 4-mm size. Even with a 4-mm collimator, there are many examples in the literature of larger than expected volumes of tissue affected after GK pallidotomy or thalamotomy.…”

Section: Problems With Lesion Sizementioning

confidence: 96%

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Complications of Gamma Knife Surgery for Parkinson Disease

Okun¹,

Stover²,

Subramanian³

et al. 2001

Arch Neurol

105

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The 8 patients with PD seen in referral at our center for complications of GK surgery highlight a spectrum of potential problems associated with this procedure. These include lesion accuracy and size and the delayed development of neurological complications secondary to radiation necrosis. Gamma knife surgery may have a higher complication rate than has been previously appreciated due to delayed onset and underreporting. We believe that the risk-benefit ratio of the GK will require further scrutiny when considering pallidotomy or thalamotomy in patients with PD. Physicians using this technique should carefully follow up patients postoperatively for delayed complications, and fully inform patients of these potential risks.

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Section: Problems With Lesion Sizementioning

confidence: 89%

Section: Problems With Lesion Sizementioning

confidence: 96%

Complications of Gamma Knife Surgery for Parkinson Disease

Okun¹,

Stover²,

Subramanian³

et al. 2001

Arch Neurol

105

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“…Whereas there is one report of comparable benefit to radiofrequency lesioning, 99 others report limited benefits 100 and substantial complications. 101 Thus, this method cannot be recommended at the present time as standard care.…”

Section: Pallidotomymentioning

confidence: 99%

Evaluation of surgery for Parkinson’s disease

Hallett¹,

Litvan²

1999

Neurology

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the Task Force on Surgery for Parkinson's Disease* PD is a common disorder affecting on average 100 per 100,000 population. Despite the large number of medications available for the treatment of early and moderately advanced PD, options specifically designed for the patient with advanced disease are limited. Surgery for PD dates from 1939-1940, when Bucy and Case 1 and Klemme 2 excised parts of the cerebral cortex to treat tremor and dystonia, but this type of surgery produced hemiparesis. Surgical basal ganglia lesions were introduced a few years later by Meyers, 3,4 who found that pallidotomy produced significant relief of tremor, rigidity, and dyskinesias, but with considerable mortality. Stereotaxic techniques to coagulate the globus pallidus in PD were introduced in the 1950s by Spiegel and Wycis, 5,6 and Cooper was an early advocate of pallidal surgery.7 Based on the anatomic connections between the pallidum and the thalamus, Hassler introduced the concept of surgery on the ventrolateral nucleus of the thalamus. 8,9Microelectrode recording allowed Narabayashi 10,11 to find that lesioning the ventral intermediate (Vim) nucleus of the thalamus was the most specific target to control the tremor in PD. Neurosurgery reached its peak in the 1960s, but declined after the introduction of levodopa.The recent resurgence of surgery was initiated by adrenal medullary transplantation. The premise of adrenal medullary transplants was that these cells, when transplanted into patients with advanced PD, would survive and function as a new source of dopamine. The theoretical advantages of adrenal tissue include that the tissue comes from the patient, eliminating the issue of immunologic rejection; dopamine is a normal intermediate compound made by the chromaffin cells; and chromaffin cells may have neuritic morphology when grown in culture. The disadvantages include the non-neuronal source and the rather modest survival rates of cells in laboratory transplantation studies. Isolated case reports of effective treatment of advanced PD with unilateral transplantation of adrenal medullary cells into the striatum in the 1980s led to several clinical trials testing the safety and efficacy of this procedure.Fetal mesencephalon transplantation was introduced subsequently and is based on several considerations. First, PD is associated with relatively selective degeneration of dopaminergic cells located in the substantia nigra, a portion of the mesencephalon. Second, replacement of dopaminergic activity by means of precursor drugs, receptor agonists, or inhibitors of dopamine catabolism improves the signs and symptoms of PD. Third, laboratory evidence in experimental animals has demonstrated that grafts of dopamine-containing neurons improve behavioral models of PD. Fourth, in these animal models, grafts reinnervate the striatum and form synaptic connections with host neurons. As a result, a small number of research teams have developed programs for human fetal mesencephalic cell grafts in PD patients. Several published reports exist,...

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“…Eight studies described clinical cases. 4,14,24,27,28,42,61,70 Okun et al 61 described improvement of tremor in 87.5% of 8 patients. Only 2 clinical case studies quantified changes in the scores, reporting 67% and 100% improvement.…”

Section: Resultsmentioning

confidence: 99%

“…49 Eight studies were classified as case reports; however, one of these reports comprised a series of 8 patients. 4,14,24,27,28,42,61,70 There were 3 prospective studies 41,55,79 and 2 comparative studies. 51,85 The remaining studies were singleinstitution series.…”

Section: Resultsmentioning

confidence: 99%

Stereotactic radiosurgery for tremor: systematic review

Martínez-Moreno

Sahgal

Salles

et al. 2019

Journal of Neurosurgery

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OBJECTIVE The aim of this systematic review is to offer an objective summary of the published literature relating to stereotactic radiosurgery (SRS) for tremor and consensus guideline recommendations. METHODS This systematic review was performed up to December 2016. Article selection was performed by searching the MEDLINE (PubMed) and EMBASE electronic bibliographic databases. The following key words were used: "radiosurgery" and "tremor" or "Parkinson's disease" or "multiple sclerosis" or "essential tremor" or "thalamotomy" or "pallidotomy." The search strategy was not limited by study design but only included key words in the English language, so at least the abstract had to be in English. RESULTS A total of 34 full-text articles were included in the analysis. Three studies were prospective studies, 1 was a retrospective comparative study, and the remaining 30 were retrospective studies. The one retrospective comparative study evaluating deep brain stimulation (DBS), radiofrequency thermocoagulation (RFT), and SRS reported similar tremor control rates, more permanent complications after DBS and RFT, more recurrence after RFT, and a longer latency period to clinical response with SRS. Similar tremor reduction rates in most of the reports were observed with SRS thalamotomy (mean 88%). Clinical complications were rare and usually not permanent (range 0%-100%, mean 17%, median 2%). Follow-up in general was too short to confirm long-term results. CONCLUSIONS SRS to the unilateral thalamic ventral intermediate nucleus, with a dose of 130-150 Gy, is a well-tolerated and effective treatment for reducing medically refractory tremor, and one that is recommended by the International Stereotactic Radiosurgery Society.

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Gamma knife pallidotomy: Case report

Cited by 18 publications

References 21 publications

Complications of Gamma Knife Surgery for Parkinson Disease

Complications of Gamma Knife Surgery for Parkinson Disease

Evaluation of surgery for Parkinson’s disease

Stereotactic radiosurgery for tremor: systematic review

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