Thalamotomy and Caudatotomy with the Gamma Knife as a Treatment for Parkinsonism with a Comment on Lesion Sizes

Friehs, Gerhard; Ojakangas, C.L.; Pachatz, P.; Schröttner, O.; Ott, Erwin; Pencil, G.

doi:10.1159/000098781

Cited by 41 publications

(12 citation statements)

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“…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: 91%

Stereotactic radiosurgery for functional disorders

Friehs

Park

Goldman

et al. 2007

FOC

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✓ 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.

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Section: Treatment Of Tremorsmentioning

confidence: 91%

Stereotactic radiosurgery for functional disorders

Friehs

Park

Goldman

et al. 2007

FOC

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“…reported an experience of radiosurgical thalamotomy (n=3) and caudatotomy (n=10), with clinical improvement in most patients and no morbidity. [8]…”

Section: Radiosurgical Thalamotomymentioning

confidence: 99%

Trends and importance of radiosurgery for the development of functional neurosurgery

Kondziolka¹,

Flickinger²,

Niranjan³

et al. 2012

Surg Neurol Int

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Functional neurosurgery includes surgery conducted to ablate, augment, or modulate targets that lead to improvement in neurological function or behavior. Surgical approaches for this purpose include destructive lesioning with different mechanical or biologic agents or energy sources, non-destructive electrical modulation, and cellular or chemical augmentation. Our purpose was to review the role of stereotactic radiosurgery used for functional indications and to discuss future applications and potential techniques. Imaging and neurophysiological research will enable surgeons to consider new targets and circuits that may be clinically important. Radiosurgery is one minimal access approach to those targets.

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“…In 1991, Lindquist et al [7] reported 2 cases of Gamma Knife thalamotomy with good relief of tremor in one and partial relief in other [7]. Friehs et al [8] reported a good response at 3-4 weeks in all 3 patients treated using a single 4-mm collimator with a maximum dose of 160 Gy. Duma et al [9] performed 38 thalamotomies for parkinsonian tremor using the Gamma Knife unit and reported complete elimination in 24%, excellent relief in 26% and good improvement in 31% of the patients.…”

Section: Gamma Knife Thalamotomymentioning

confidence: 99%

A Comparison of Surgical Approaches for the Management of Tremor: Radiofrequency Thalamotomy, Gamma Knife Thalamotomy and Thalamic Stimulation

Niranjan

Jawahar

Kondziolka

et al. 1999

Stereotact Funct Neurosurg

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Objective: Between April 1994 and January 1999, 39 stereotactic procedures for patients with intractable tremor were performed at the University of Pittsburgh Medical Center. A retrospective analysis of results of radiosurgical thalamotomy (n = 15), MR-guided stereotactic radiofrequency thalamotomy (n = 13), and deep brain thalamic stimulation (DBS; n = 11) was performed to study relative advantages and risks of these procedures. Methods: All options were discussed with the patients, but radiosurgery usually was performed in elderly patients with concurrent medical problems. Stereotactic thalamotomy and DBS was performed with MR guidance and macrostimulation. For radiosurgery, a median dose of 140 Gy (range 130–150 Gy) was delivered using a single 4-mm collimator. Results: Of the 13 patients who underwent radiofrequency thalamotomy, 5 had immediate complete arrest of tremor, 6 had a significant reduction and 2 had partial reduction. All 11 patients who underwent DBS had excellent control of tremor immediately after the procedure, and in longer-term follow-up 10/11 maintained excellent tremor control. Of the 12 evaluable radiosurgery patients, 10 noted excellent relief and 2 had partial relief. Conclusion: Stereotactic procedures for tremor control are safe and effective. Each procedure has specific advantages and disadvantages that are important for patient selection.

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Thalamotomy and Caudatotomy with the Gamma Knife as a Treatment for Parkinsonism with a Comment on Lesion Sizes

Cited by 41 publications

References 0 publications

Stereotactic radiosurgery for functional disorders

Stereotactic radiosurgery for functional disorders

Trends and importance of radiosurgery for the development of functional neurosurgery

A Comparison of Surgical Approaches for the Management of Tremor: Radiofrequency Thalamotomy, Gamma Knife Thalamotomy and Thalamic Stimulation

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