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Bilateral pallidotomy for treatment of idiopathic Parkinson's disease
1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Beijing 100053, China.
Objective:
To clarify the benefits and risks of patients undergoing bilateral posteroventral pallidotomy (BPVP) for patients with idiopathic Parkinson's disease (PD) and the differences between contemporaneous BPVP (CBPVP) and staged BPVP (SBPVP).
Methods:
Twenty patients underwent microelectrode-guided CBPVP and 26 SBPVP for bilateral PD symptoms. The data were retrospectively reviewed. Unified Parkinson's Disease Rating Scale (UPDRS) was used to evaluate the effects of these operations.
Results:
BPVP, either CBPVP or SBPVP, significantly improved patients' bilateral PD symptoms (P < 0.001). The improvement was consistently higher in "off" state than in "on" state. No statistical difference was observed in the improvement percentages of CBPVP, SBPVP1 and SBPVP2. CBPVP contributed greatly to L-dopa induced side effects (part IV). BPVP, SBPVP1, and SBPVP2 significantly improved cardinal parkinsonian signs but no difference was found among them. One patient after CBPVP developed hypophonia and swallowing problem, while 2 patients after SBPVP sustained hypophonia. These conditions were improved 3 months later.
Conclusions:
BPVP may significantly improve bilateral signs of PD. It is safer than bilateral thalamotomy. CBPVP is applicable to some patients. BPVP may not cause mental impairment but shows a higher incidence rate of hypophonia. The practice of BPVP requires a refined surgical technique and a better understanding of pathophysiology of the basal ganglia.