Gamma Knife Thalamotomy and Pallidotomy in Patients with Movement Disorders: Preliminary Results

Rand, Robert W.; Jacques, David; Melbye, Roy Wilbur; Copcutt, Brian; Fisher, M.R.; Levenick, M.N.

doi:10.1159/000100662

Cited by 52 publications

(32 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The effect of the surgery on parkinsonian symptoms is delayed for several weeks to months as the GK-induced lesion develops. There have been few reports [5][6][7][8][9][10][11][12][13][14][15] of short-or longterm complications of GK surgery for PD ( Table 1). This article follows the recent and important review by Lang 4 suggesting that there is little reliable evidence that GK radiosurgery can be safely applied to patients with PD.…”

Section: Discussionmentioning

confidence: 99%

Complications of Gamma Knife Surgery for Parkinson Disease

Okun¹,

Stover²,

Subramanian³

et al. 2001

Arch Neurol

105

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications of Gamma Knife Surgery for Parkinson Disease

Okun¹,

Stover²,

Subramanian³

et al. 2001

Arch Neurol

105

View full text Add to dashboard Cite

show abstract

“…1). The authors of several studies have reported success rates in tremor control in patients with PD, essential tremor, and tremor related to multiple sclerosis or other causes 13,17,41,42,43,51,68,69,72 that are comparable to those achieved using other methods. Complications are usually rare, mild, and temporary, although unusual complications 62 and severe, permanent complications 47 have also been reported.…”

Section: Treatment Of Tremorsmentioning

confidence: 92%

“…The first reports of using GKS in the treatment of tremor were published in the early 1990s, when Rand et al 51 in the United States, Lindquist and colleagues 35 in Europe, and Ohye et al 44 in Japan described their experiences. The positive findings of these groups have since been duplicated at numerous treatment centers around the world.…”

Section: Treatment Of Tremorsmentioning

confidence: 99%

See 1 more Smart Citation

Stereotactic radiosurgery for functional disorders

Friehs

Park

Goldman

et al. 2007

FOC

View full text Add to dashboard Cite

✓ Stereotactic radiosurgery (SRS) with the Gamma Knife and linear accelerator has revolutionized neurosurgery over the past 20 years. The most common indications for radiosurgery today are tumors and arteriovenous malformations of the brain. Functional indications such as treatment of movement disorders or intractable pain only contribute a small percentage of treated patients. Although SRS is the only noninvasive form of treatment for functional disorders, it also has some limitations: neurophysiological confirmation of the target structure is not possible, and one therefore must rely exclusively on anatomical targeting. Furthermore, lesion sizes may vary, and shielding adjacent radiosensitive neural structures may be difficult or impossible. The most common indication for functional SRS is the treatment of trigeminal neuralgia. Radiosurgical treatment for epilepsy and certain psychiatric illnesses is performed in several centers as part of strict research protocols, and radiosurgical pallidotomy or medial thalamotomy is no longer recommended due to the high risk of complications. Radiosurgical ventrolateral thalamotomy for the treatment of tremor in patients with Parkinson disease or multiple sclerosis, as well as in the treatment of essential tremor, may be indicated for a select group of patients with advanced age, significant medical conditions that preclude treatment with open surgery, or patients who must receive anticoagulation therapy. A promising new application of SRS is high-dose radiosurgery delivered to the pituitary stalk. This treatment has already been successfully performed in several centers around the world to treat severe pain in patients with end-stage cancer.

show abstract

“…Included in this review are seven patients described by us in a previous communication. [21] The goals of our study were: 1) to determine the efficacy of the procedure; 2) to see if there is a dose-response relationship; 3) to review the radiological findings of radiosurgical lesioning; and 4) to assess the risks of complications.…”

mentioning

confidence: 99%

Gamma knife radiosurgery for thalamotomy in Parkinsonian tremor: a five-year experience

Duma¹,

Jacques²,

Kopyov³

et al. 1997

FOC

View full text Add to dashboard Cite

Certain patients, for example elderly, high-risk surgical patients, may be unfit for radiofrequency thalamotomy to treat Parkinsonian tremor. Some patients, when given the opportunity, may choose to avoid an invasive surgical procedure. The authors retrospectively reviewed their experience using gamma knife radiosurgery for thalamotomies in this patient subpopulation. Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make 38 lesions in 24 men and 10 women (median age 73 years, range 58-87 years) over a 5-year period. A median radiation dose of 130 Gy (range 100-165 Gy) was delivered to 38 nuclei (four patients underwent bilateral thalamotomy) using a single 4-mm collimator following classic anatomical landmarks. Twenty-nine lesions were made in the left nucleus ventralis intermedius thalamus for right-sided tremor. Patients were followed for a median of 28 months (range 6-58 months). Independent neurological evaluation of tremor based on the change in the Unified Parkinson's Disease Rating Scale tremor score was correlated with subjective patient evaluation. Comparison was made between a subgroup of patients in whom “low-dose” lesions were made (range 110-135 Gy, mean 120 Gy) and those in whom “high-dose” lesions were made (range 140-165 Gy, mean 160 Gy) for purposes of dose-response information. Four thalamotomies (10.5%) failed, four (10.5%) produced mild improvement, 11 (29%) produced good improvement, and 10 (26%) produced excellent relief of tremor. In nine thalamotomies (24%) the tremor was eliminated completely. The median time to onset of improvement was 2 months (range 1 week-8 months) Concordance between an independent neurologist's evaluation and that of the patient was statistically significant (p < 0.001). Two patients who underwent unilateral thalamotomy experienced bilateral improvement of their tremor. There were no neurological complications. There was better tremor reduction in the high-dose group when compared with the low-dose group (p < 0.04). Although less effective than other stereotactic techniques, gamma knife radiosurgical thalamotomy offers tremor control with minimal risk to a patient population unsuited for open surgery.

show abstract

Gamma Knife Thalamotomy and Pallidotomy in Patients with Movement Disorders: Preliminary Results

Cited by 52 publications

References 2 publications

Complications of Gamma Knife Surgery for Parkinson Disease

Complications of Gamma Knife Surgery for Parkinson Disease

Stereotactic radiosurgery for functional disorders

Gamma knife radiosurgery for thalamotomy in Parkinsonian tremor: a five-year experience

Contact Info

Product

Resources

About