Stereotactic Radiosurgery for Intractable Tremor-Dominant Parkinson Disease: A Retrospective Analysis

Area of Science:

• Neurosurgery
• Neurology
• Radiosurgery

Background:

• Parkinson disease (PD) often presents with medically refractory tremor.
• Deep brain stimulation and thermal thalamotomy are established treatments but may not be suitable for all patients.

Purpose of the Study:

• To retrospectively analyze the outcomes of stereotactic radiosurgery using Gamma Knife thalamotomy (GKT) for Parkinson disease (PD) tremor.
• To evaluate the safety and efficacy of GKT in managing medically refractory PD tremor.

Main Methods:

• Retrospective analysis of 33 patients with PD tremor treated with GKT over 19 years.
• Median radiation dose of 140 Gy delivered to the nucleus ventralis intermedius via a single isocenter.
• Tremor assessed using the Fahn-Tolosa-Marin clinical tremor rating scale; follow-up up to 144 months.

Main Results:

• Significant tremor improvement in 93.9% of patients post-GKT.
• Complete or near-complete tremor arrest achieved in 70.0% of patients.
• Sustained tremor relief in 96.8% of responders; temporary adverse radiation effects in 6%.

Conclusions:

• Gamma Knife thalamotomy (GKT) is a safe and effective treatment for medically refractory PD tremor.
• GKT is particularly beneficial for elderly patients or those ineligible for deep brain stimulation or thermal thalamotomy.