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Ventral intermediate thalamotomy for posttraumatic hemiballismus.

M F Lévesque1, C H Markham

  • 1Division of Neurosurgery, UCLA School of Medicine.

Stereotactic and Functional Neurosurgery
|January 1, 1992
PubMed
Summary
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This study presents a rare case of hemiballismus, a movement disorder, following head injury. Stereotactic thalamotomy successfully resolved the persistent symptoms after 16 years.

Area of Science:

  • Neurology
  • Neurosurgery
  • Movement Disorders

Background:

  • Hemiballismus is a rare hyperkinetic movement disorder characterized by violent, involuntary limb movements.
  • It is often associated with lesions in the subthalamic nucleus, but can occur with other basal ganglia or related structure involvement.
  • Persistent hemiballismus following head injury presents a significant management challenge.

Observation:

  • A patient presented with a 16-year history of intractable hemiballismus after a closed head injury.
  • Extensive preoperative investigations, including neuroimaging, failed to identify a specific causative lesion in the basal ganglia or subthalamic nucleus.
  • The patient's condition significantly impacted quality of life and was refractory to medical management.

Findings:

Related Experiment Videos

  • A stereotactic ventral intermediate thalamotomy was performed as a last resort treatment.
  • The surgical intervention resulted in complete and sustained resolution of the hemiballistic movements.
  • Follow-up at 12 months post-surgery confirmed the absence of abnormal movements.

    • Implications:

    • This case highlights the potential efficacy of stereotactic thalamotomy for managing long-standing, treatment-resistant hemiballismus, even in the absence of a clearly defined lesion.
    • It suggests that the ventral intermediate nucleus of the thalamus may be a viable target for ablative surgery in selected cases of hemiballismus.
    • Further research into the neuroanatomical correlates and optimal surgical targets for post-traumatic hemiballismus is warranted.