Clinical outcome of unilateral stereotactic pallidotomy without microelectrode recording for intractable Parkinson's disease.
OBJECTIVE
To study the effects of unilateral stereotactic pallidotomy performed without microelectrode recording for advanced Parkinson's disease.


METHODS
Stereotactic coordinates were calculated by comparing preoperative inversion recovery MRI sequences with intraoperative CT scans. Conventional stereotactic stimulation techniques were employed to confirm correct probe placement. Patients were assessed using a modified CAPIT protocol with the off-state UPDRS motor score as the primary efficacy measure.


RESULTS
A statistically significant decline in off-state UPDRS motor scores occurred at 2months (21% improvement in 32 patients) and also at 1year postoperatively (30% improvement in 12 patients). Levodopa-induced dyskinesias on the side contralateral to surgery were reduced 97% in the cohort with 1year of follow-up. No deleterious effects of surgery on global neuropsychological functioning were seen. A major surgical complication (mild but persistent hemiparesis) occurred in one patient.


CONCLUSIONS
We believe that stereotactic pallidotomy can be performed safely and effectively without microelectrode recording when coordinates are calculated using CT with comparison to preoperative MRI sequences.
Dewey
R B
RB
Department of Neurology, UT Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75235-9036, USA.
Giller
C A
CA
Broline
S K
SK
Mendelsohn
D B
DB
Lacritz
L H
LH
Cullum
C M
CM