Long-term follow-up results of selective VIM-thalamotomy

Abstract

The authors report the results of a long-term follow-up study of the effects of the physiologically defined selective VIM (nucleus ventralis intermedius)-thalamotomy on tremor of Parkinson's disease in 27 patients and essential tremor in 16 patients. The follow-up period ranged from 3.25 to 10 years (mean 6.58 years). In 43 patients a total of 50 operations (including four bilateral operations and three reoperations) were carried out. The early (2 to 4 weeks after surgery) and late effects on the tremors were determined clinically and electromyographically. Fourteen parkinsonian cases were treated with minimal lesions (about 40 cu mm). Their late results were very similar to the early results: in 10, the tremors were completely abolished, three had a slight residual tremor, and one underwent reoperation 3 months after the first surgery. Eleven essential tremor cases were treated with minimal lesions. Six of these tremors were completely abolished, four patients had slight residual tremors, and one patient with a recurrence underwent reoperation 2 years after the initial surgery. In these 23 successful operations with minimal lesions (excluding two cases with reoperation), the tremor was abolished without discernible long-lasting side effects. The other 23 operations on 16 patients with Parkinson's disease (including one reoperation) and on seven with essential tremor (one of whom also had a minimal lesion on the other side) involved relatively large lesions. In this group, the surgery was successful in almost every case. It was concluded that radiographically and physiologically monitored selective VIM-thalamotomy for parkinsonian and essential tremor is effective even when lesioning is minimal. Moreover, the beneficial effect is maintained over a long period of time.

Motor performance after posteroventral pallidotomy and VIM-thalamotomy in Parkinson's disease: a 1-year follow-up study

“…The surgical complications (Table 2) in this group of patients were similar to those described in the literature 5,6,8,11,12,[31][32][33][34][35] . For TVL, the studies reported complication rates between 36 and 61%, for PVP they range from 6,3 to 66,6%.…”

“…The reports of the pre-levodopa era [2][3][4] used nonvalidated methods of assessment, and those patients presented a different clinical profile when compared to the patients of the levodopa era. More recent studies [5][6][7][8][9][10][11][12][13][14][15][16] present different methods of assessment, leading to different conclusions.…”

Avaliação das atividades da vida diária dos pacientes com doença de Parkinson submetidos a cirurgia estereotáxica

“…A escolha do alvo cirúrgico neste estudo segue a tendência atual da literatura, que indica a PPV nos casos nos quais a bradicinesia, flutuações decorrentes do uso da levodopa e ocorrência de discinesias são predominantes [2][3][4]12,[14][15][16][17][18][19] . A TVL é indicada nos casos onde há predomínio da rigidez e do tremor [20][21][22][23][24] . Nosso estudo assemelha-se muito com o de Ferraz et al 25 , quanto à técnica cirúrgica e escolha do alvo cirúrgico.…”

“…Perry e Lenz 24 apresentam uma revisão de trabalhos realizados com pacientes submetidos a TVL que apresentavam complicações transitórias, dentre elas: disartria, disfasia, hemiparesia e alterações mentais. Outro trabalho também apresenta resultado semelhante 21 .…”

Neuronal activity and outcomes from thalamic surgery for spinocerebellar ataxia

“…Some patients with SCA show a vigorous action tremor intractable to medical therapy. There is a long history of functional neurosurgery targeting the ventral intermediate nucleus (Vim) of the thalamus for treatment of tremor, most often for essential tremor (ET) 3, 4. ET is not associated with overt ataxia, but a subset of ET was disclosed to involve a pathological abnormality of the cerebellum .5 The mode of tremor is similar, dominantly intention‐type action tremor, and the mechanism of tremor is estimated to share the same anatomical structures in SCA and ET 5, 6.…”