Comparison of thalamotomy and pallidotomy for the treatment of dystonia.
OBJECTIVE
Thalamotomy and, more recently, pallidotomy have been used to treat selected patients with intractable dystonia, although few studies have compared the effectiveness of these two surgical procedures. In this study, we compare our results using thalamotomy and pallidotomy to treat patients with different forms of dystonia, and we discuss our results in the context of other published series.


METHODS
Thirty-two patients with intractable dystonia underwent thalamotomy (n = 18) or pallidotomy (n = 14). Dystonia was classified according to cause and distribution, and each patient was evaluated postoperatively at two or more time points, using a global outcome scale.


RESULTS
Although comparisons are limited by differences between the two surgical groups, including longer follow-up periods for the thalamotomy group, differences in symptom distribution, and more bilateral procedures for the pallidotomy group, patients with primary dystonia who underwent pallidotomies demonstrated significantly better long-term outcomes than did patients who underwent thalamotomies (P = 0.0467). Patients with secondary dystonia experienced more modest improvements after either procedure, with little or no difference in outcomes between the two procedures.


CONCLUSIONS
For patients with primary dystonia, pallidotomy seems to result in better outcomes than does thalamotomy.
Yoshor
D
D
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA. dyoshor@bcm.tmc.edu
Hamilton
W J
WJ
Ondo
W
W
Jankovic
J
J
Grossman
R G
RG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004421:Dystonia / Q000209:etiology / Q000601:surgery*; D004564:Electrocoagulation; D005260:Female; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome