title: Thalamotomy and caudatotomy with the Gamma Knife as a treatment for parkinsonism with a comment on lesion sizes.
abstract: Radiosurgery with the Gamma Knife was performed in 12 patients with parkinsonism. In 9 patients small lesions were created in the head of the caudate nucleus bilaterally. Two patients underwent radiosurgical thalamotomy, and 1 patient was treated with caudatotomy and thalamotomy. After a follow-up period of 1-12 months, 9 patients of the caudatotomy group and all patients with thalamotomies showed clear benefit. There was no complication or side effect that could be related to the treatment. Pre- and postoperative testing was performed with the Unified Parkinson Rating Scale and with objective motor tasks. Caudatotomy proved to be an effective treatment for bradykinesia and rigidity, while tremor was ameliorated by thalamotomy. Functional neurosurgery with the Gamma Knife would seem to be a good alternative to open procedures with low morbidity and no mortality. Advantages and drawbacks of radiosurgical techniques for the treatment of parkinsonism are discussed.
authors.affiliation: Department of Neurosurgery, University of Graz, Austria.
authors.forename: G M
authors.initials: GM
authors.lastname: Friehs
authors.forename: C L
authors.initials: CL
authors.lastname: Ojakangas
authors.forename: P
authors.initials: P
authors.lastname: Pachatz
authors.forename: O
authors.initials: O
authors.lastname: Schröttner
authors.forename: E
authors.initials: E
authors.lastname: Ott
authors.forename: G
authors.initials: G
authors.lastname: Pendl
mesh_terms: D000368:Aged; D002421:Caudate Nucleus / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D013787:Thalamic Nuclei / Q000473:pathology / Q000601:surgery*