Abstract
TWENTY-EIGHT CENTERS COMPLETED a survey about their current practice of pallidotomy. This sample represents a non-exhaustive survey of the current practice of pallidotomy in North America and is not a study of outcomes. 1015 patients underwent 1219 pallidotomies: 811 (80%) unilateral, 72 (7%) staged bilateral, and 132 (13%) simultaneous bilateral. Pallidotomy has long been an accepted procedure and the indications for this surgery, in the opinion of the responding centers, were rated on a scale of 1 (poor) to 4 (excellent) and demonstrated dyskinesia as the best indication (median =4); on-off fluctuations, dystonia, rigidity, and bradykinesia as good indications (median =3); and freezing, tremor and gait disturbances as fair indications (median =2). Most centers used MRI alone (50%) or in combination with CT scan (n=6) or ventriculography (n=5) to localize the target. The median values of pallidal coordinates were: 2 mm anterior to the midcommissural point, 21 mm lateral to the midsagittal plane and 5 mm below the intercommissural line. Microrecording was performed by half of the centers (n=14) and half of the remaining centers were considering starting it (n=7). Main criteria used to define the target included the firing pattern of spontaneous neuronal discharges (n=13) and the response to joint movement (n=10). Most centers performed motor (n=26) and visual (n=23) macrostimulation. Twenty four centers performed test lesions using median values of 55 °C temperatures for 30 s. Final lesions consisted of 3 permanent lesions placed 2 mm apart, each lesion created with median values of 75 °C temperatures for 1 minute. Median hospital stay was 2 days.
Original language | English (US) |
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Pages (from-to) | 883-892 |
Number of pages | 10 |
Journal | Neurosurgery |
Volume | 39 |
Issue number | 4 |
DOIs | |
State | Published - Oct 1996 |
Keywords
- Microrecording
- Movement disorders
- Pallidotomy
- Parkinson's disease
- Survey
ASJC Scopus subject areas
- Surgery
- Clinical Neurology