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Analysis of complications of radiofrequency pallidotomy
Zhang Hua1, Gao Guodong, Liang Qinchuan
1Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China. zhanghua@fmmu.edu.cn
Objective:
To systematically report the complications of pallidotomy and to tentatively determine the incidences of complications of pallidotomy, possible influencing factors, and the acceptability of symptomatic hemorrhage rates for microelectrode-guided pallidotomy.
Methods:
Clinical events were analyzed for 1116 patients with Parkinson's disease who underwent microelectrode-guided pallidotomies at our center. Complications included visual field deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, speech disorders, hiccups, hemorrhage, seizures, apraxia, coma, infection, mental confusion, and impaired memory. Complication rates for bilateral pallidotomy and double-lesion groups were compared with those for unilateral pallidotomy and single-lesion groups, respectively.
Results:
Among the total of 1116 patients, the incidences of visual field deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, and speech disorders were 0.4, 4.2, 19.9, 12.4, 7.0, 3.7, and 11.9%, respectively. Symptomatic hemorrhage was observed for 17 patients, apraxia for 3 patients, coma for 2 patients, mental confusion for 24 patients, and impaired memory for 18 of the 1116 patients. The incidences of fatigue, speech disorders, drooling, dysphagia, and hypersomnia were 18.1, 10.3, 5.2, 2.4, and 11.6%, respectively, in the unilateral pallidotomy group and 34.9, 25.5, 22.6, 14.2, and 17.0%, respectively, in the staged pallidotomy group. Of the three patients who underwent simultaneous bilateral pallidotomies (all <50 yr of age), all developed severe fatigue and two exhibited drooling and dysphagia. The incidences of weakness, fatigue, speech disorders, drooling, dysphagia, and hypersomnia were 8.7, 30.4, 18.8, 7.2, 2.9, and 20.3%, respectively, in the double-lesion group and 3.2, 17.2, 9.7, 5.0, 2.3, and 11.5%, respectively, in the single-lesion group.
Conclusion:
Staged bilateral pallidotomy should be carefully evaluated before decision-making, whereas simultaneous bilateral pallidotomy is undesirable. Our study suggests that the size of the final lesion should be limited, to minimize the risks of complications. The incidence of symptomatic hemorrhage in microelectrode-guided pallidotomy is low and acceptable, because of the benefits of microelectrode-guided pallidotomy.
Insights
Microelectrode-guided pallidotomy for Parkinson's disease shows a low rate of symptomatic hemorrhage. Careful evaluation is needed for staged bilateral procedures, while simultaneous bilateral pallidotomy is not recommended.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Pallidotomy is a neurosurgical procedure used to treat Parkinson's disease.
- Microelectrode guidance is employed to enhance precision during pallidotomy.
- Complications associated with pallidotomy require systematic reporting and analysis.
Purpose of the Study:
- To systematically document complications following pallidotomy.
- To determine complication rates and influencing factors in microelectrode-guided pallidotomy.
- To assess the acceptability of symptomatic hemorrhage rates in this procedure.
Main Methods:
- Analysis of clinical events in 1116 Parkinson's disease patients undergoing microelectrode-guided pallidotomy.
- Inclusion of complications such as visual deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, speech disorders, hiccups, hemorrhage, seizures, apraxia, coma, infection, confusion, and memory impairment.
- Comparison of complication rates between unilateral and bilateral pallidotomy, and single-lesion versus double-lesion groups.
Main Results:
- Incidences of specific complications: visual field deficits (0.4%), weakness (4.2%), fatigue (19.9%), hypersomnia (12.4%), drooling (7.0%), dysphagia (3.7%), and speech disorders (11.9%).
- Symptomatic hemorrhage observed in 17 patients; other significant complications included mental confusion (24 patients) and impaired memory (18 patients).
- Higher rates of fatigue, speech disorders, drooling, dysphagia, and hypersomnia were noted in staged bilateral pallidotomy groups compared to unilateral procedures.
Conclusions:
- Staged bilateral pallidotomy requires careful consideration due to increased complication risks.
- Simultaneous bilateral pallidotomy is generally not advised.
- Limiting the size of the final lesion is recommended to minimize complication risks.
- The incidence of symptomatic hemorrhage is low and acceptable, highlighting the benefits of microelectrode-guided pallidotomy.