Pallidotomy: a comparison of responders and nonresponders.
OBJECTIVE
We reviewed a prospective series of 32 unilateral, large-volume, microelectrode-guided posteroventral pallidotomies to determine the differences between responsive and nonresponsive patients.


METHODS
Our patients underwent extensive pre- and postoperative evaluations. One year postoperatively, we correlated the outcomes of 25 patients with their histories, physical findings, neuropsychological assessments, and lesion characteristics to further understand the indications, limitations, and pitfalls of unilateral pallidotomy. Our group judged responsiveness by comparing the preoperative total Unified Parkinson's Disease Rating Scale off-state scores with those obtained 1 year postoperatively. A score indicating greater than 20% improvement at 1-year follow-up was rated a good outcome; improvement of greater than 40% was rated an excellent outcome.


RESULTS
Although most patients sustained long-term benefits, some demonstrated little or no improvement. Patient and lesion factors influenced outcome. Younger age (<60 yr), tremor, unilateral predominance, L-dopa responsiveness, motor fluctuations with dyskinesia, and good lesion placement predicted a good response to unilateral pallidotomy. Advanced age (>70 yr), absence of tremor, increased duration of disease, reduced responsiveness to L-dopa, frontal behavioral changes, prominent apraxic phenomena, and improper lesion placement predicted a poor response.


CONCLUSIONS
Unilateral, large-volume pallidotomy with precise lesion control provides long-lasting benefits for carefully selected patients.
Van Horn
G
G
Department of Neurology, University of Texas Health Science Center, University of Texas Medical School, Houston, USA. gage.van.horn@uth.tmc.edu
Hassenbusch
S J
SJ
Zouridakis
G
G
Mullani
N A
NA
Wilde
M C
MC
Papanicolaou
A C
AC
D000368:Aged; D005917:Globus Pallidus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008839:Microelectrodes; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013238:Stereotaxic Techniques; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome