Destructive stereotactic surgery for treatment of dystonia.
BACKGROUND
This study is a retrospective review of the results of stereotactic destructive surgery in selected cases of drug-resistant dystonia.


METHODS
Fifty-eight patients with drug-resistant dystonia were treated with stereotactic surgery between 1991 and 1999 in our institution. These patients' charts were retrospectively analyzed. The timing of the conducted evaluations was as follows: preoperatively, postoperatively, in the postoperative 1st week, 6th month, 12th month, and also thereafter every year.


RESULTS
Symptoms of dystonia occurred before the age of 10 years in 30 patients (51.8%) and after the age of 10 years in 28 patients (48.2%). Generalized dystonia was detected in 41 patients, whereas 11 patients had hemidystonia, 5 patients had focal dystonia, and 1 patient had segmental dystonia. The most common etiologic factor was CP (n = 34). A total of 103 ablative lesions were created in 86 surgical sessions. Thalamotomy, pallidotomy, subthalamotomy, and the region of Forel lesions were performed either separately or in combination. In this series, the mean follow-up time was 102.2 months. Except for 2 cases of temporary hemiparesis, no other complications were observed. Minor improvement was obtained in 17 patients (19.7%), improvement of a medium degree was obtained in 17 patients (19.7%), high-degree improvement was obtained in 11 (12.8%), and very high degree improvement was obtained in 16 (18.6%) patients. A final evaluation revealed permanent improvement in 32 patients (55.2%).


CONCLUSIONS
Production of stereotactic destructive lesions in certain specified targets is a safe method that improves quality of life and aids ambulation in patients with dystonia resistant to medical therapy.
Imer
Murat
M
Department of Neurosurgery, Istanbul Faculty of Medicine, University of Istanbul, Capa-Istanbul 34390, Turkey.
Murat
Imer
I
Ozeren
Bekir
B
Bekir
Ozeren
O
Karadereler
Selhan
S
Selhan
Karadereler
K
Yapici
Zuhal
Z
Zuhal
Yapici
Y
Omay
Bülent
B
Bülent
Omay
O
Hanağasi
Haşmet
H
Hanğasi
Haşmet
H
Haşmet
Hanağasi
H
Eraksoy
Mefkure
M
Mefkure
Eraksoy
E
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D020530:Subthalamus / Q000601:surgery*; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome