Background
Parkinson's Disease (PD), Essential Tremors (ET), and Dystonia are movement disorder diseases that are managed surgically. Deep brain nuclei include the globus pallidus internus (GPI), ventral intermediate nucleus (VIM), and subthalamic nucleus (STN). Proper choice of the target is based on the appropriate diagnosis, patient's symptoms, and possible adverse effects following the ablative surgery.
Methods
We had 40 patients diagnosed with movement disorders. A complete neurological assessment was done on the patients. 3D MRI was done to the patients for diagnosis and preoperative target planning.
Results:
We had 30 males and ten females. Twenty-four had PD, 14 had ET, and two had dystonia. We did pallidotomy in four cases, thalamotomy in 22 cases, subthalamotomy on eight patients, and combined pallidotomy and VIM thalamotomy on six patients. The thalamotomy group had a remarkable improvement in tremors. The subthalamotomy or combined pallidotomy and thalamotomy groups had an improvement in all three cardinal PD symptoms, improvement in the ON/OFF fluctuations, and a reduction in L-Dopa Induced dyskinesia. Patients who had a pallidotomy had an improvement in bradykinesia, and rigidity, improvement in the ON/OFF fluctuations, and a reduction in L-Dopa induced dyskinesia.
Two patients suffered from hematoma, four ataxia, one contralateral hypothesia, and one hypophonia. One hemiballismus, two, contralateral weaknesses, and one urine incontinence.
Conclusions:
Proper planning and choice of target is an essential cornerstone to reaching the best results. When choosing the target for stereotactic ablation, all functional neurosurgeons dealing with movement disorders must know all anticipated outcomes and possible complications.