title: Analysis of complications of radiofrequency pallidotomy.
abstract: OBJECTIVE
  To systematically report the complications of pallidotomy and to tentatively determine the incidences of complications of pallidotomy, possible influencing factors, and the acceptability of symptomatic hemorrhage rates for microelectrode-guided pallidotomy.
  
  
  METHODS
  Clinical events were analyzed for 1116 patients with Parkinson's disease who underwent microelectrode-guided pallidotomies at our center. Complications included visual field deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, speech disorders, hiccups, hemorrhage, seizures, apraxia, coma, infection, mental confusion, and impaired memory. Complication rates for bilateral pallidotomy and double-lesion groups were compared with those for unilateral pallidotomy and single-lesion groups, respectively.
  
  
  RESULTS
  Among the total of 1116 patients, the incidences of visual field deficits, weakness, fatigue, hypersomnia, drooling, dysphagia, and speech disorders were 0.4, 4.2, 19.9, 12.4, 7.0, 3.7, and 11.9%, respectively. Symptomatic hemorrhage was observed for 17 patients, apraxia for 3 patients, coma for 2 patients, mental confusion for 24 patients, and impaired memory for 18 of the 1116 patients. The incidences of fatigue, speech disorders, drooling, dysphagia, and hypersomnia were 18.1, 10.3, 5.2, 2.4, and 11.6%, respectively, in the unilateral pallidotomy group and 34.9, 25.5, 22.6, 14.2, and 17.0%, respectively, in the staged pallidotomy group. Of the three patients who underwent simultaneous bilateral pallidotomies (all <50 yr of age), all developed severe fatigue and two exhibited drooling and dysphagia. The incidences of weakness, fatigue, speech disorders, drooling, dysphagia, and hypersomnia were 8.7, 30.4, 18.8, 7.2, 2.9, and 20.3%, respectively, in the double-lesion group and 3.2, 17.2, 9.7, 5.0, 2.3, and 11.5%, respectively, in the single-lesion group.
  
  
  CONCLUSIONS
  Staged bilateral pallidotomy should be carefully evaluated before decision-making, whereas simultaneous bilateral pallidotomy is undesirable. Our study suggests that the size of the final lesion should be limited, to minimize the risks of complications. The incidence of symptomatic hemorrhage in microelectrode-guided pallidotomy is low and acceptable, because of the benefits of microelectrode-guided pallidotomy.
authors.affiliation: Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China. zhanghua@fmmu.edu.cn
authors.forename: Zhang
authors.initials: Z
authors.lastname: Hua
authors.forename: Gao
authors.initials: G
authors.lastname: Guodong
authors.forename: Liang
authors.initials: L
authors.lastname: Qinchuan
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yaqun
authors.forename: Wang
authors.initials: W
authors.lastname: Qinfen
authors.forename: Wang
authors.initials: W
authors.lastname: Xuelian
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography / Q000295:instrumentation; D005260:Female; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016634:Radiosurgery / Q000295:instrumentation; D012086:Reoperation; D012306:Risk; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation