Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy.
OBJECTIVE
To investigate the potential operative morbidity in posteroventral pallidotomy (PVP) for patients with Parkinson's disease.


METHODS
We designed a retrospective study that included 796 consecutive patients (mean age, 64.9 yr; male, 559; female, 237) with Parkinson's disease. All PVPs (simultaneous bilateral PVP, n = 272; sequential bilateral PVP, n = 88; unilateral PVP, n = 436) were performed during a 7-year period. The total number of operations was 884, and the number of PVP procedures was 1156. In 108 patients, ventral intermediate nucleus thalamotomy was performed simultaneously.


RESULTS
The overall complication rate, including temporary problems, was 15.3% of 884 operations. Permanent complications occurred in 3.6% of total operations. Intracranial hemorrhage occurred in 24 operations (2.7%). In seven of them, the patients required craniotomy and hematoma evacuation and sustained a disabling motor deficit (0.8%). Intracranial hemorrhage occurred more often in patients who underwent microelectrode recording and had a history of chronic hypertension. Hemiparesis without intracranial hematoma occurred in 12 operations (1.4%). Microelectrode recording was a risk factor for postoperative hemiparesis without hemorrhage. In 19 operations (2.1%), patients developed a partial visual field deficit. Speech disturbance after surgery was observed in 23 operations (2.6%) but resolved in 17 by 1 week after surgery. In 55 operations (6.2%), patients developed postoperative confusion. This occurred more often in elderly patients and those with advanced disease. In 17 operations (1.9%), patients required observation in the intensive care unit because of postoperative hypotension.


CONCLUSIONS
Complications from stereotactic pallidotomy were not frequent. However, the residual symptoms from complications can be serious in many cases.
Higuchi
Yoshinori
Y
Division of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Iacono
Robert Paul
RP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D020651:Ventral Thalamic Nuclei / Q000601:surgery*