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Published on: December 13, 2017
[Radiofrequency Lesioning Surgery for Movement Disorders]
Shiro Horisawa1, Takaomi Taira
1Department of Neurosurgery, Tokyo Women's Medical University.
Abstract:
Radiofrequency lesioning surgery is primarily performed to treat Parkinson's disease, dystonia, and tremor. Its effects are similar to those of deep brain stimulation (DBS). However, Radiofrequency lesioning surgery has not been popularized, possibly due to the over-evaluation of its risks. The current most available targets for the treatment of movement disorders include ventral intermediate (Vim) nucleus, ventral oral (Vo) nucleus, and globus pallidus internus (GPi). Vim thalamotomy is available for Parkinsonian tremor, essential tremor, dystonic tremor, and other various kinds of tremor, and it is highly effective. Bilateral vim thalamotomy is feasible when properly performed on tiny lesions on the bilateral vim nucleus. Vo thalamotomy is mainly available for focal hand dystonia. The safety profile of bilateral Vo thalamotomy has not yet been established, but it is thought that it may lead to irreversible hypophonia and dysarthria. Pallidotomy is selected for treatment of dystonia and Parkinson's disease. Although unilateral pallidotomy is a safe procedure, it can cause medically refractory parkinsonism including postural reflex disturbance and gait disorder. Delayed infarction on the posterior limb of internal capsule is another major concern associated with pallidotomy and can lead to hemiparesis. Correct understanding is absolutely essential to ensure the safety of radiofrequency lesioning surgery.
Insights
Radiofrequency lesioning surgery offers effective treatment for Parkinson's disease, dystonia, and tremors, similar to deep brain stimulation (DBS). Understanding surgical targets and potential risks is crucial for patient safety.
Area of Science:
- Neurosurgery
- Neurology
- Movement Disorders
Background:
- Radiofrequency lesioning surgery is an established treatment for movement disorders like Parkinson's disease, dystonia, and tremor.
- Its therapeutic effects are comparable to deep brain stimulation (DBS).
- The technique's limited popularity may stem from an overemphasis on its associated risks.
Purpose of the Study:
- To review the primary targets and efficacy of radiofrequency lesioning surgery for movement disorders.
- To discuss the safety profiles and potential complications associated with lesioning specific brain nuclei.
- To emphasize the importance of accurate understanding for safe surgical practice.
Main Methods:
- Review of existing literature on radiofrequency lesioning targets and outcomes.
- Analysis of the efficacy and safety of Vim thalamotomy, Vo thalamotomy, and pallidotomy.
- Discussion of potential neurological deficits associated with each procedure.
Main Results:
- Ventral intermediate (Vim) nucleus thalamotomy is highly effective for various tremors.
- Ventral oral (Vo) nucleus thalamotomy is indicated for focal hand dystonia, with caution regarding speech and voice.
- Globus pallidus internus (GPi) pallidotomy is used for dystonia and Parkinson's disease, with risks including gait disturbance and hemiparesis.
Conclusions:
- Radiofrequency lesioning surgery provides effective treatment options for specific movement disorders.
- Careful target selection and a thorough understanding of potential risks, such as speech impairment or hemiparesis, are essential.
- Accurate knowledge is paramount to ensure the safe application of radiofrequency lesioning surgery.
